Methods of adjusting a virtual implant and related surgical navigation systems

ABSTRACT

Methods may be provided to operate an image-guided surgical system using imaging information for a 3-dimensional anatomical volume. A pose of a probe that defines a longitudinal axis may be detected based on information received from a tracking system. A placement of a virtual implant for the 3-dimensional anatomical volume may be determined based on the pose of the probe and based on an offset from an end of the probe along the longitudinal axis, such that a trajectory of the virtual implant is in alignment with the longitudinal axis of the probe in the pose. After determining the placement of the virtual implant, the virtual implant may be adjusted in response to movement of the probe while maintaining the trajectory of the virtual implant.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 15/609,334 which is a continuation-in-part of U.S. patentapplication Ser. No. 15/157,444, filed May 18, 2016, which is acontinuation-in-part of U.S. patent application Ser. No. 15/095,883,filed Apr. 11, 2016, which is a continuation-in-part of U.S. patentapplication Ser. No. 14/062,707, filed on Oct. 24, 2013, which is acontinuation-in-part application of U.S. patent application Ser. No.13/924,505, filed on Jun. 21, 2013, which claims priority to provisionalapplication No. 61/662,702 filed on Jun. 21, 2012 and claims priority toprovisional application No. 61/800,527 filed on Mar. 15, 2013, all ofwhich are incorporated by reference herein in their entireties for allpurposes.

FIELD

The present disclosure relates to medical devices, and moreparticularly, surgical navigation systems and related methods anddevices.

BACKGROUND

Medical imaging systems may be used to generate images of athree-dimensional (3D) volume of a body. Position recognition systemscan be used to determine the position of and track a particular objectin 3D). In robot assisted surgeries, for example, certain objects, suchas surgical instruments, may need to be tracked with a high degree ofprecision as the instrument is being positioned and moved by a robot orby a physician, for example.

Infrared signal based position recognition systems may use passiveand/or active sensors or markers to track the objects. In passivesensors or markers, objects to be tracked may include passive sensors,such as reflective spherical balls, which are positioned at strategiclocations on the object to be tracked. Infrared transmitters transmit asignal, and the reflective spherical balls reflect the signal to aid indetermining the position of the object in 3D. In active sensors ormarkers, the objects to be tracked include active infrared transmitters,such as light emitting diodes (LEDs), and thus generate their owninfrared signals for 3D detection. With either active or passivetracking sensors, the system then geometrically resolves the 3D positionof the active and/or passive sensors based on information from or withrespect to one or more of the infrared cameras, digital signals, knownlocations of the active or passive sensors, distance, the time it tookto receive the responsive signals, other known variables, or acombination thereof.

These surgical systems can therefore utilize position feedback toprecisely guide movement of robotic arms and tools relative to apatients' surgical site. However, these systems lack an ability tovirtually plan and prepare for the placement of some tools and implantsprior to the surgery.

SUMMARY

According to some embodiments of inventive concepts, methods may beprovided to operate an image-guided surgical system using imaginginformation for a 3-dimensional anatomical volume. A pose of a probethat defines a longitudinal axis may be detected based on informationreceived from a tracking system. A placement of a virtual implant forthe 3-dimensional anatomical volume can be determined based on the poseof the probe and based on an offset from an end of the probe along thelongitudinal axis, such that a trajectory of the virtual implant is inalignment with the longitudinal axis of the probe in the pose. Afterdetermining the placement of the virtual implant, the virtual implantcan be adjusted responsive to movement of the probe while maintainingthe trajectory of the virtual implant.

According to still other embodiments of inventive concepts, a surgicalnavigation system using imaging information for a 3-dimensionalanatomical volume can include a processor and a memory coupled with theprocessor. The memory can include instructions stored therein. Theinstructions can be executed by the processor to cause the processor todetect a pose of a probe that defines a longitudinal axis based oninformation received from a tracking system. The instructions can beexecuted by the processor to further cause the processor to determine aplacement of a virtual implant for the 3-dimensional anatomical volumebased on the pose of the probe and based on an offset from an end of theprobe along the longitudinal axis, such that a trajectory of the virtualimplant is in alignment with the longitudinal axis of the probe in thepose. The instructions can be executed by the processor to cause theprocessor to, after providing the placement of the virtual implant,adjust the virtual implant responsive to movement of the probe whilemaintaining the trajectory of the virtual implant.

Other methods and related imaging and tracking systems, andcorresponding methods and computer program products according toembodiments of the inventive subject matter will be or become apparentto one with skill in the art upon review of the following drawings anddetailed description. It is intended that all such imaging and trackingsystems, and corresponding methods and computer program products beincluded within this description, be within the scope of the presentinventive subject matter, and be protected by the accompanying claims.Moreover, it is intended that all embodiments disclosed herein can beimplemented separately or combined in any way and/or combination.

DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the disclosure and constitute a part of thisapplication, illustrate certain non-limiting embodiments of inventiveconcepts. In the drawings:

FIG. 1 is an overhead view of a potential arrangement for locations ofthe robotic system, patient, doctor, and other medical personnel duringa medical procedure;

FIG. 2 illustrates the robotic system including positioning of themedical robot and the camera relative to the patient according to someembodiments;

FIG. 3 illustrates a medical robotic system in accordance with someembodiments;

FIG. 4 illustrates a portion of a medical robot in accordance with someembodiments;

FIG. 5 illustrates a block diagram of a medical robot in accordance withsome embodiments;

FIG. 6 illustrates a medical robot in accordance with some embodiments;

FIGS. 7A-7C illustrate an end-effector in accordance with someembodiments;

FIG. 8 illustrates a medical instrument and the end-effector, before andafter, inserting the medical instrument into the guide tube of theend-effector according to some embodiments;

FIGS. 9A-9C illustrate portions of an end-effector and robot arm inaccordance with some embodiments;

FIG. 10 illustrates a dynamic reference array, an imaging array, andother components in accordance with some embodiments;

FIG. 11 illustrates a method of registration in accordance with someembodiments;

FIGS. 12A-12B illustrate embodiments of imaging devices according tosome embodiments;

FIG. 13A illustrates a portion of a robot including the robot arm and anend-effector in accordance with some embodiments;

FIG. 13B is a close-up view of the end-effector, with a plurality oftracking markers rigidly affixed thereon, shown in FIG. 13A;

FIG. 13C is a tool or instrument with a plurality of tracking markersrigidly affixed thereon according to some embodiments;

FIG. 14A is an alternative version of an end-effector with moveabletracking markers in a first configuration;

FIG. 14B is the end-effector shown in FIG. 14A with the moveabletracking markers in a second configuration;

FIG. 14C shows the template of tracking markers in the firstconfiguration from FIG. 14A;

FIG. 14D shows the template of tracking markers in the secondconfiguration from FIG. 14B;

FIG. 15A shows an alternative version of the end-effector having only asingle tracking marker affixed thereto;

FIG. 15B shows the end-effector of FIG. 15A with an instrument disposedthrough the guide tube;

FIG. 15C shows the end-effector of FIG. 15A with the instrument in twodifferent positions, and the resulting logic to determine if theinstrument is positioned within the guide tube or outside of the guidetube;

FIG. 15D shows the end-effector of FIG. 15A with the instrument in theguide tube at two different frames and its relative distance to thesingle tracking marker on the guide tube;

FIG. 15E shows the end-effector of FIG. 15A relative to a coordinatesystem;

FIG. 16 is a block diagram of a method for navigating and moving theend-effector of the robot to a desired target trajectory;

FIGS. 17A-17B depict an instrument for inserting an expandable implanthaving fixed and moveable tracking markers in contracted and expandedpositions, respectively;

FIGS. 18A-18B depict an instrument for inserting an articulating implanthaving fixed and moveable tracking markers in insertion and angledpositions, respectively;

FIG. 19A depicts an embodiment of a robot with interchangeable oralternative end-effectors;

FIG. 19B depicts an embodiment of a robot with an instrument styleend-effector coupled thereto;

FIG. 20 is a block diagram illustrating a controller according to someembodiments;

FIG. 21 illustrates a tracking system detecting a probe and determininga placement of a virtual implant according to some embodiments;

FIG. 22 is a flow chart illustrating example operations of a surgicalrobotic navigation system according to some embodiments; and

FIGS. 23A and 23B are examples of a telescoping probe according to someembodiments.

FIGS. 24A and 24B, and FIG. 25 and FIG. 26 depict examples of movementsof a probe that may be detected by a tracking system and used to adjusta placement of a virtual implant according to some embodiments; and

DETAILED DESCRIPTION

It is to be understood that the present disclosure is not limited in itsapplication to the details of construction and the arrangement ofcomponents set forth in the description herein or illustrated in thedrawings. The teachings of the present disclosure may be used andpracticed in other embodiments and practiced or carried out in variousways. Also, it is to be understood that the phraseology and terminologyused herein is for the purpose of description and should not be regardedas limiting. The use of “including,” “comprising,” or “having” andvariations thereof herein is meant to encompass the items listedthereafter and equivalents thereof as well as additional items. Unlessspecified or limited otherwise, the terms “mounted,” “connected,”“supported,” and “coupled” and variations thereof are used broadly andencompass both direct and indirect mountings, connections, supports, andcouplings. Further, “connected” and “coupled” are not restricted tophysical or mechanical connections or couplings.

The following discussion is presented to enable a person skilled in theart to make and use embodiments of the present disclosure. Variousmodifications to the illustrated embodiments will be readily apparent tothose skilled in the art, and the principles herein can be applied toother embodiments and applications without departing from embodiments ofthe present disclosure. Thus, the embodiments are not intended to belimited to embodiments shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures, in which like elements in different figures have like referencenumerals. The figures, which are not necessarily to scale, depictselected embodiments and are not intended to limit the scope of theembodiments. Skilled artisans will recognize the examples providedherein have many useful alternatives and fall within the scope of theembodiments.

Turning now to the drawings, FIGS. 1 and 2 illustrate a medical robotsystem 100 in accordance with some embodiments. Medical robot system 100may include, for example, a medical robot 102, one or more robot arms104, a base 106, a display 110, an end-effector 112, for example,including a guide tube 114, and one or more tracking markers 118. Themedical robot system 100 may include a patient tracking device 116 alsoincluding one or more tracking markers 118, which is adapted to besecured directly to the patient 210 (e.g., to a bone of the patient210). The medical robot system 100 may also use a camera(s) 200, forexample, positioned on a camera stand 202. The camera stand 202 can haveany suitable configuration to move, orient, and support the camera 200in a desired position. The camera 200 may include any suitable camera orcameras, such as one or more infrared cameras (e.g., bifocal orstereophotogrammetric cameras), able to identify, for example, activeand passive tracking markers 118 (shown as part of patient trackingdevice 116 in FIG. 2 and shown by enlarged view in FIGS. 13A-13B) in agiven measurement volume viewable from the perspective of the camera200. The camera 200 may scan the given measurement volume and detect thelight that comes from the markers 118 in order to identify and determinethe position of the markers 118 in three-dimensions. For example, activemarkers 118 may include infrared-emitting markers that are activated byan electrical signal (e.g., infrared light emitting diodes (LEDs)),and/or passive markers 118 may include retro-reflective markers thatreflect infrared light (e.g., they reflect incoming IR radiation intothe direction of the incoming light), for example, emitted byilluminators on the camera 200 or other suitable device.

FIGS. 1 and 2 illustrate a potential configuration for the placement ofthe medical robot system 100 in an operating room environment. Forexample, the robot 102 may be positioned near or next to patient 210.Although depicted near the head of the patient 210, it will beappreciated that the robot 102 can be positioned at any suitablelocation near the patient 210 depending on the area of the patient 210undergoing the operation. The camera 200 may be separated from the robotsystem 100 and positioned at the foot of patient 210. This locationallows the camera 200 to have a direct visual line of sight to themedical field 208. Again, it is contemplated that the camera 200 may belocated at any suitable position having line of sight to the medicalfield 208. In the configuration shown, the doctor 120 may be positionedacross from the robot 102, but is still able to manipulate theend-effector 112 and the display 110. A medical assistant 126 may bepositioned across from the doctor 120 again with access to both theend-effector 112 and the display 110. If desired, the locations of thedoctor 120 and the assistant 126 may be reversed. The traditional areasfor the anesthesiologist 122 and the nurse or scrub tech 124 may remainunimpeded by the locations of the robot 102 and camera 200.

With respect to the other components of the robot 102, the display 110can be attached to the medical robot 102 and in some embodiments,display 110 can be detached from medical robot 102, either within asurgical room (or other medical facility) with the medical robot 102, orin a remote location. End-effector 112 may be coupled to the robot arm104 and controlled by at least one motor. In some embodiments,end-effector 112 can comprise a guide tube 114, which is able to receiveand orient a medical instrument 608 (described further herein) used onthe patient 210. As used herein, the term “end-effector” is usedinterchangeably with the terms “end-effectuator” and “effectuatorelement.” Although generally shown with a guide tube 114, it will beappreciated that the end-effector 112 may be replaced with any suitableinstrumentation suitable for use in surgery. In some embodiments,end-effector 112 can comprise any known structure for effecting themovement of the medical instrument 608 in a desired manner.

The medical robot 102 is able to control the translation and orientationof the end-effector 112. The robot 102 is able to move end-effector 112along x-, y-, and z-axes, for example. The end-effector 112 can beconfigured for selective rotation about one or more of the x-, y-, andz-axis, and a Z Frame axis (such that one or more of the Euler Angles(e.g., roll, pitch, and/or yaw) associated with end-effector 112 can beselectively controlled). In some embodiments, selective control of thetranslation and orientation of end-effector 112 can permit performanceof medical procedures with significantly improved accuracy compared toconventional robots that use, for example, a six degree of freedom robotarm comprising only rotational axes. For example, the medical robotsystem 100 may be used to provide medical imaging and/or to operate onpatient 210, and robot arm 104 can be positioned above the body ofpatient 210, with end-effector 112 selectively angled relative to thez-axis toward the body of patient 210.

In some embodiments, the position of the medical instrument 608 can bedynamically updated so that medical robot 102 can be aware of thelocation of the medical instrument 608 at all times during theprocedure. Consequently, in some embodiments, medical robot 102 can movethe medical instrument 608 to the desired position quickly without anyfurther assistance from a physician (unless the physician so desires).In some further embodiments, medical robot 102 can be configured tocorrect the path of the medical instrument 608 if the medical instrument608 strays from the selected, preplanned trajectory. In someembodiments, medical robot 102 can be configured to permit stoppage,modification, and/or manual control of the movement of end-effector 112and/or the medical instrument 608. Thus, in use, in some embodiments, aphysician or other user can operate the system 100, and has the optionto stop, modify, or manually control the autonomous movement ofend-effector 112 and/or the medical instrument 608. Further details ofmedical robot system 100 including the control and movement of a medicalinstrument 608 by medical robot 102 can be found in co-pending U.S.patent application Ser. No. 13/924,505, which is incorporated herein byreference in its entirety.

The robotic medical system 100 can comprise one or more tracking markers118 configured to track the movement of robot arm 104, end-effector 112,patient 210, and/or the medical instrument 608 in three dimensions. Insome embodiments, a plurality of tracking markers 118 can be mounted (orotherwise secured) thereon to an outer surface of the robot 102, suchas, for example and without limitation, on base 106 of robot 102, onrobot arm 104, and/or on the end-effector 112. In some embodiments, atleast one tracking marker 118 of the plurality of tracking markers 118can be mounted or otherwise secured to the end-effector 112. One or moretracking markers 118 can further be mounted (or otherwise secured) tothe patient 210. In some embodiments, the plurality of tracking markers118 can be positioned on the patient 210 spaced apart from the medicalfield 208 to reduce the likelihood of being obscured by the doctor,medical tools, or other parts of the robot 102. Further, one or moretracking markers 118 can be further mounted (or otherwise secured) tothe medical tools 608 (e.g., an ultrasound transducer, a screw driver,dilator, implant inserter, or the like). Thus, the tracking markers 118enable each of the marked objects (e.g., the end-effector 112, thepatient 210, and the medical tools 608) to be tracked by the robot 102.In some embodiments, system 100 can use tracking information collectedfrom each of the marked objects to calculate the orientation andlocation, for example, of the end-effector 112, the medical instrument608 (e.g., positioned in the tube 114 of the end-effector 112), and therelative position of the patient 210.

The markers 118 may include radiopaque or optical markers. The markers118 may be suitably shaped include spherical, spheroid, cylindrical,cube, cuboid, or the like. In some embodiments, one or more of markers118 may be optical markers. In some embodiments, the positioning of oneor more tracking markers 118 on end-effector 112 can increase/maximizethe accuracy of the positional measurements by serving to check orverify the position of end-effector 112. Further details of medicalrobot system 100 including the control, movement and tracking of medicalrobot 102 and of a medical instrument 608 can be found in U.S. patentpublication No. 2016/0242849, which is incorporated herein by referencein its entirety.

Some embodiments include one or more markers 118 coupled to the medicalinstrument 608. In some embodiments, these markers 118, for example,coupled to the patient 210 and medical instruments 608, as well asmarkers 118 coupled to the end-effector 112 of the robot 102 cancomprise conventional infrared light-emitting diodes (LEDs) or anOptotrak® diode capable of being tracked using a commercially availableinfrared optical tracking system such as Optotrak®. Optotrak® is aregistered trademark of Northern Digital Inc., Waterloo, Ontario,Canada. In other embodiments, markers 118 can comprise conventionalreflective spheres capable of being tracked using a commerciallyavailable optical tracking system such as Polaris Spectra. PolarisSpectra is also a registered trademark of Northern Digital, Inc. In someembodiments, the markers 118 coupled to the end-effector 112 are activemarkers which comprise infrared light-emitting diodes which may beturned on and off, and the markers 118 coupled to the patient 210 andthe medical instruments 608 comprise passive reflective spheres.

In some embodiments, light emitted from and/or reflected by markers 118can be detected by camera 200 and can be used to monitor the locationand movement of the marked objects. In alternative embodiments, markers118 can comprise a radio-frequency and/or electromagnetic reflector ortransceiver and the camera 200 can include or be replaced by aradio-frequency and/or electromagnetic transceiver.

Similar to medical robot system 100, FIG. 3 illustrates a medical robotsystem 300 and camera stand 302, in a docked configuration, consistentwith some embodiments of the present disclosure. Medical robot system300 may comprise a robot 301 including a display 304, upper arm 306,lower arm 308, end-effector 310, vertical column 312, casters 314,cabinet 316, tablet drawer 318, connector panel 320, control panel 322,and ring of information 324. Camera stand 302 may comprise camera 326.These components are described in greater with respect to FIG. 5. FIG. 3illustrates the medical robot system 300 in a docked configuration wherethe camera stand 302 is nested with the robot 301, for example, when notin use. It will be appreciated by those skilled in the art that thecamera 326 and robot 301 may be separated from one another andpositioned at any appropriate location during the medical procedure, forexample, as shown in FIGS. 1 and 2.

FIG. 4 illustrates a base 400 consistent with some embodiments of thepresent disclosure. Base 400 may be a portion of medical robot system300 and comprise cabinet 316. Cabinet 316 may house certain componentsof medical robot system 300 including but not limited to a battery 402,a power distribution module 404, a platform interface board module 406,a computer 408, a handle 412, and a tablet drawer 414. The connectionsand relationship between these components is described in greater detailwith respect to FIG. 5.

FIG. 5 illustrates a block diagram of certain components of someembodiments of medical robot system 300. Medical robot system 300 maycomprise platform subsystem 502, computer subsystem 504, motion controlsubsystem 506, and tracking subsystem 532. Platform subsystem 502 mayfurther comprise battery 402, power distribution module 404, platforminterface board module 406, and tablet charging station 534. Computersubsystem 504 may further comprise computer 408, display 304, andspeaker 536. Motion control subsystem 506 may further comprise drivercircuit 508, motors 510, 512, 514, 516, 518, stabilizers 520, 522, 524,526, end-effector 310, and controller 538. Tracking subsystem 532 mayfurther comprise position sensor 540 and camera converter 542. System300 may also comprise a foot pedal 544 and tablet 546.

Input power is supplied to system 300 via a power source 548 which maybe provided to power distribution module 404. Power distribution module404 receives input power and is configured to generate different powersupply voltages that are provided to other modules, components, andsubsystems of system 300. Power distribution module 404 may beconfigured to provide different voltage supplies to platform interfacemodule 406, which may be provided to other components such as computer408, display 304, speaker 536, driver 508 to, for example, power motors512, 514, 516, 518 and end-effector 310, motor 510, ring 324, cameraconverter 542, and other components for system 300 for example, fans forcooling the electrical components within cabinet 316.

Power distribution module 404 may also provide power to other componentssuch as tablet charging station 534 that may be located within tabletdrawer 318. Tablet charging station 534 may be in wireless or wiredcommunication with tablet 546 for charging table 546. Tablet 546 may beused by a doctor consistent with the present disclosure and describedherein.

Power distribution module 404 may also be connected to battery 402,which serves as temporary power source in the event that powerdistribution module 404 does not receive power from input power 548. Atother times, power distribution module 404 may serve to charge battery402 if necessary.

Other components of platform subsystem 502 may also include connectorpanel 320, control panel 322, and ring 324. Connector panel 320 mayserve to connect different devices and components to system 300 and/orassociated components and modules. Connector panel 320 may contain oneor more ports that receive lines or connections from differentcomponents. For example, connector panel 320 may have a ground terminalport that may ground system 300 to other equipment, a port to connectfoot pedal 544 to system 300, a port to connect to tracking subsystem532, which may comprise position sensor 540, camera converter 542, andcameras 326 associated with camera stand 302. Connector panel 320 mayalso include other ports to allow USB, Ethernet, HDMI communications toother components, such as computer 408.

Control panel 322 may provide various buttons or indicators that controloperation of system 300 and/or provide information regarding system 300.For example, control panel 322 may include buttons to power on or offsystem 300, lift or lower vertical column 312, and lift or lowerstabilizers 520-526 that may be designed to engage casters 314 to locksystem 300 from physically moving. Other buttons may stop system 300 inthe event of an emergency, which may remove all motor power and applymechanical brakes to stop all motion from occurring. Control panel 322may also have indicators notifying the user of certain system conditionssuch as a line power indicator or status of charge for battery 402.

Ring 324 may be a visual indicator to notify the user of system 300 ofdifferent modes that system 300 is operating under and certain warningsto the user.

Computer subsystem 504 includes computer 408, display 304, and speaker536. Computer 504 includes an operating system and software to operatesystem 300. Computer 504 may receive and process information from othercomponents (for example, tracking subsystem 532, platform subsystem 502,and/or motion control subsystem 506) in order to display information tothe user. Further, computer subsystem 504 may also include speaker 536to provide audio to the user.

Tracking subsystem 532 may include position sensor 504 and converter542. Tracking subsystem 532 may correspond to camera stand 302 includingcamera 326 as described with respect to FIG. 3. Position sensor 504 maybe camera 326. Tracking subsystem may track the location of certainmarkers that are located on the different components of system 300and/or instruments used by a user during a medical procedure. Thistracking may be conducted in a manner consistent with the presentdisclosure including the use of infrared technology that tracks thelocation of active or passive elements, such as LEDs or reflectivemarkers, respectively. The location, orientation, and position ofstructures having these types of markers may be provided to computer 408which may be shown to a user on display 304. For example, a medicalinstrument 608 having these types of markers and tracked in this manner(which may be referred to as a navigational space) may be shown to auser in relation to a three dimensional image of a patient's anatomicalstructure.

Motion control subsystem 506 may be configured to physically movevertical column 312, upper arm 306, lower arm 308, or rotateend-effector 310. The physical movement may be conducted through the useof one or more motors 510-518. For example, motor 510 may be configuredto vertically lift or lower vertical column 312. Motor 512 may beconfigured to laterally move upper arm 308 around a point of engagementwith vertical column 312 as shown in FIG. 3. Motor 514 may be configuredto laterally move lower arm 308 around a point of engagement with upperarm 308 as shown in FIG. 3. Motors 516 and 518 may be configured to moveend-effector 310 in a manner such that one may control the roll and onemay control the tilt, thereby providing multiple angles thatend-effector 310 may be moved. These movements may be achieved bycontroller 538 which may control these movements through load cellsdisposed on end-effector 310 and activated by a user engaging these loadcells to move system 300 in a desired manner.

Moreover, system 300 may provide for automatic movement of verticalcolumn 312, upper arm 306, and lower arm 308 through a user indicatingon display 304 (which may be a touchscreen input device) the location ofa medical instrument or component on a three dimensional image of thepatient's anatomy on display 304. The user may initiate this automaticmovement by stepping on foot pedal 544 or some other input means.

FIG. 6 illustrates a medical robot system 600 consistent with someembodiments. Medical robot system 600 may comprise end-effector 602,robot arm 604, guide tube 606, instrument 608, and robot base 610.Instrument tool 608 may be attached to a tracking array 612 includingone or more tracking markers (such as markers 118) and have anassociated trajectory 614. Trajectory 614 may represent a path ofmovement that instrument tool 608 is configured to travel once it ispositioned through or secured in guide tube 606, for example, a path ofinsertion of instrument tool 608 into a patient. In an operation, robotbase 610 may be configured to be in electronic communication with robotarm 604 and end-effector 602 so that medical robot system 600 may assista user (for example, a doctor) in operating on the patient 210. Medicalrobot system 600 may be consistent with previously described medicalrobot system 100 and 300.

A tracking array 612 may be mounted on instrument 608 to monitor thelocation and orientation of instrument tool 608. The tracking array 612may be attached to an instrument 608 and may comprise tracking markers804. As best seen in FIG. 8, tracking markers 804 may be, for example,light emitting diodes and/or other types of reflective markers (e.g.,markers 118 as described elsewhere herein). The tracking devices may beone or more line of sight devices associated with the medical robotsystem. As an example, the tracking devices may be one or more cameras200, 326 associated with the medical robot system 100, 300 and may alsotrack tracking array 612 for a defined domain or relative orientationsof the instrument 608 in relation to the robot arm 604, the robot base610, end-effector 602, and/or the patient 210. The tracking devices maybe consistent with those structures described in connection with camerastand 302 and tracking subsystem 532.

FIGS. 7A, 7B, and 7C illustrate a top view, front view, and side view,respectively, of end-effector 602 consistent with some embodiments.End-effector 602 may comprise one or more tracking markers 702. Trackingmarkers 702 may be light emitting diodes or other types of active andpassive markers, such as tracking markers 118 that have been previouslydescribed. In some embodiments, the tracking markers 702 are activeinfrared-emitting markers that are activated by an electrical signal(e.g., infrared light emitting diodes (LEDs)). Thus, tracking markers702 may be activated such that the infrared markers 702 are visible tothe camera 200, 326 or may be deactivated such that the infrared markers702 are not visible to the camera 200, 326. Thus, when the markers 702are active, the end-effector 602 may be controlled by the system 100,300, 600, and when the markers 702 are deactivated, the end-effector 602may be locked in position and unable to be moved by the system 100, 300,600.

Markers 702 may be disposed on or within end-effector 602 in a mannersuch that the markers 702 are visible by one or more cameras 200, 326 orother tracking devices associated with the medical robot system 100,300, 600. The camera 200, 326 or other tracking devices may trackend-effector 602 as it moves to different positions and viewing anglesby following the movement of tracking markers 702. The location ofmarkers 702 and/or end-effector 602 may be shown on a display 110, 304associated with the medical robot system 100, 300, 600, for example,display 110 as shown in FIG. 2 and/or display 304 shown in FIG. 3. Thisdisplay 110, 304 may allow a user to ensure that end-effector 602 is ina desirable position in relation to robot arm 604, robot base 610, thepatient 210, and/or the user.

For example, as shown in FIG. 7A, markers 702 may be placed around thesurface of end-effector 602 so that a tracking device placed away fromthe medical field 208 and facing toward the robot 102, 301 and thecamera 200, 326 is able to view at least 3 of the markers 702 through arange of common orientations of the end-effector 602 relative to thetracking device. For example, distribution of markers 702 in this wayallows end-effector 602 to be monitored by the tracking devices whenend-effector 602 is translated and rotated in the medical field 208.

In addition, in some embodiments, end-effector 602 may be equipped withinfrared (IR) receivers that can detect when an external camera 200, 326is getting ready to read markers 702. Upon this detection, end-effector602 may then illuminate markers 702. The detection by the IR receiversthat the external camera 200, 326 is ready to read markers 702 maysignal the need to synchronize a duty cycle of markers 702, which may belight emitting diodes, to an external camera 200, 326. This may alsoallow for lower power consumption by the robotic system as a whole,whereby markers 702 would only be illuminated at the appropriate timeinstead of being illuminated continuously. Further, in some embodiments,markers 702 may be powered off to prevent interference with othernavigation tools, such as different types of medical instruments 608.

FIG. 8 depicts one type of medical instrument 608 including a trackingarray 612 and tracking markers 804. Tracking markers 804 may be of anytype described herein including but not limited to light emitting diodesor reflective spheres. Markers 804 are monitored by tracking devicesassociated with the medical robot system 100, 300, 600 and may be one ormore of the line of sight cameras 200, 326. The cameras 200, 326 maytrack the location of instrument 608 based on the position andorientation of tracking array 612 and markers 804. A user, such as adoctor 120, may orient instrument 608 in a manner so that tracking array612 and markers 804 are sufficiently recognized by the tracking deviceor camera 200, 326 to display instrument 608 and markers 804 on, forexample, display 110 of the medical robot system.

The manner in which a doctor 120 may place instrument 608 into guidetube 606 of the end-effector 602 and adjust the instrument 608 isevident in FIG. 8. The hollow tube or guide tube 114, 606 of theend-effector 112, 310, 602 is sized and configured to receive at least aportion of the medical instrument 608. The guide tube 114, 606 isconfigured to be oriented by the robot arm 104 such that insertion andtrajectory for the medical instrument 608 is able to reach a desiredanatomical target within or upon the body of the patient 210. Themedical instrument 608 may include at least a portion of a generallycylindrical instrument. Although a screw driver is exemplified as themedical tool 608, it will be appreciated that any suitable medical tool608 may be positioned by the end-effector 602. By way of example, themedical instrument 608 may include one or more of a guide wire, cannula,a retractor, a drill, a reamer, a screw driver, an insertion tool, aremoval tool, or the like. Although the hollow tube 114, 606 isgenerally shown as having a cylindrical configuration, it will beappreciated by those of skill in the art that the guide tube 114, 606may have any suitable shape, size, and configuration desired toaccommodate the medical instrument 608 and access the medical site.

FIGS. 9A-9C illustrate end-effector 602 and a portion of robot arm 604consistent with some embodiments. End-effector 602 may further comprisebody 1202 and clamp 1204. Clamp 1204 may comprise handle 1206, balls1208, spring 1210, and lip 1212. Robot arm 604 may further comprisedepressions 1214, mounting plate 1216, lip 1218, and magnets 1220.

End-effector 602 may mechanically interface and/or engage with themedical robot system and robot arm 604 through one or more couplings.For example, end-effector 602 may engage with robot arm 604 through alocating coupling and/or a reinforcing coupling. Through thesecouplings, end-effector 602 may fasten with robot arm 604 outside aflexible and sterile barrier. In some embodiments, the locating couplingmay be a magnetically kinematic mount and the reinforcing coupling maybe a five bar over center clamping linkage.

With respect to the locating coupling, robot arm 604 may comprisemounting plate 1216, which may be non-magnetic material, one or moredepressions 1214, lip 1218, and magnets 1220. Magnet 1220 is mountedbelow each of depressions 1214. Portions of clamp 1204 may comprisemagnetic material and be attracted by one or more magnets 1220. Throughthe magnetic attraction of clamp 1204 and robot arm 604, balls 1208become seated into respective depressions 1214. For example, balls 1208as shown in FIG. 9B would be seated in depressions 1214 as shown in FIG.9A. This seating may be considered a magnetically-assisted kinematiccoupling. Magnets 1220 may be configured to be strong enough to supportthe entire weight of end-effector 602 regardless of the orientation ofend-effector 602. The locating coupling may be any style of kinematicmount that uniquely restrains six degrees of freedom.

With respect to the reinforcing coupling, portions of clamp 1204 may beconfigured to be a fixed ground link and as such clamp 1204 may serve asa five bar linkage. Closing clamp handle 1206 may fasten end-effector602 to robot arm 604 as lip 1212 and lip 1218 engage clamp 1204 in amanner to secure end-effector 602 and robot arm 604. When clamp handle1206 is closed, spring 1210 may be stretched or stressed while clamp1204 is in a locked position. The locked position may be a position thatprovides for linkage past center. Because of a closed position that ispast center, the linkage will not open absent a force applied to clamphandle 1206 to release clamp 1204. Thus, in a locked positionend-effector 602 may be robustly secured to robot arm 604.

Spring 1210 may be a curved beam in tension. Spring 1210 may becomprised of a material that exhibits high stiffness and high yieldstrain such as virgin PEEK (poly-ether-ether-ketone). The linkagebetween end-effector 602 and robot arm 604 may provide for a sterilebarrier between end-effector 602 and robot arm 604 without impedingfastening of the two couplings.

The reinforcing coupling may be a linkage with multiple spring members.The reinforcing coupling may latch with a cam or friction basedmechanism. The reinforcing coupling may also be a sufficiently powerfulelectromagnet that will support fastening end-effector 102 to robot arm604. The reinforcing coupling may be a multi-piece collar completelyseparate from either end-effector 602 and/or robot arm 604 that slipsover an interface between end-effector 602 and robot arm 604 andtightens with a screw mechanism, an over center linkage, or a cammechanism.

Referring to FIGS. 10 and 11, prior to or during a medical procedure,certain registration procedures may be conducted to track objects and atarget anatomical structure of the patient 210 both in a navigationspace and an image space. To conduct such registration, a registrationsystem 1400 may be used as illustrated in FIG. 10.

To track the position of the patient 210, a patient tracking device 116may include a patient fixation instrument 1402 to be secured to a rigidanatomical structure of the patient 210 and a dynamic reference base(DRB) 1404 may be securely attached to the patient fixation instrument1402. For example, patient fixation instrument 1402 may be inserted intoopening 1406 of dynamic reference base 1404. Dynamic reference base 1404may contain markers 1408 that are visible to tracking devices, such astracking subsystem 532. These markers 1408 may be optical markers orreflective spheres, such as tracking markers 118, as previouslydiscussed herein.

Patient fixation instrument 1402 is attached to a rigid anatomy of thepatient 210 and may remain attached throughout the medical procedure. Insome embodiments, patient fixation instrument 1402 is attached to arigid area of the patient 210, for example, a bone that is located awayfrom the targeted anatomical structure subject to the medical procedure.In order to track the targeted anatomical structure, dynamic referencebase 1404 is associated with the targeted anatomical structure throughthe use of a registration fixture that is temporarily placed on or nearthe targeted anatomical structure in order to register the dynamicreference base 1404 with the location of the targeted anatomicalstructure.

A registration fixture 1410 is attached to patient fixation instrument1402 through the use of a pivot arm 1412. Pivot arm 1412 is attached topatient fixation instrument 1402 by inserting patient fixationinstrument 1402 through an opening 1414 of registration fixture 1410.Pivot arm 1412 is attached to registration fixture 1410 by, for example,inserting a knob 1416 through an opening 1418 of pivot arm 1412.

Using pivot arm 1412, registration fixture 1410 may be placed over thetargeted anatomical structure and its location may be determined in animage space and navigation space using tracking markers 1420 and/orfiducials 1422 on registration fixture 1410. Registration fixture 1410may contain a collection of markers 1420 that are visible in anavigational space (for example, markers 1420 may be detectable bytracking subsystem 532). Tracking markers 1420 may be optical markersvisible in infrared light as previously described herein. Registrationfixture 1410 may also contain a collection of fiducials 1422, forexample, such as bearing balls, that are visible in an imaging space(for example, a three dimension CT image). As described in greaterdetail with respect to FIG. 11, using registration fixture 1410, thetargeted anatomical structure may be associated with dynamic referencebase 1404 thereby allowing depictions of objects in the navigationalspace to be overlaid on images of the anatomical structure. Dynamicreference base 1404, located at a position away from the targetedanatomical structure, may become a reference point thereby allowingremoval of registration fixture 1410 and/or pivot arm 1412 from themedical area.

FIG. 11 provides a method 1500 for registration consistent with thepresent disclosure. Method 1500 begins at step 1502 wherein a graphicalrepresentation (or image(s)) of the targeted anatomical structure may beimported into system 100, 300 600, for example computer 408. Thegraphical representation may be three dimensional CT or a fluoroscopescan of the targeted anatomical structure of the patient 210 whichincludes registration fixture 1410 and a detectable imaging pattern offiducials 1420.

At step 1504, an imaging pattern of fiducials 1420 is detected andregistered in the imaging space and stored in computer 408. Optionally,at this time at step 1506, a graphical representation of theregistration fixture 1410 may be overlaid on the images of the targetedanatomical structure.

At step 1508, a navigational pattern of registration fixture 1410 isdetected and registered by recognizing markers 1420. Markers 1420 may beoptical markers that are recognized in the navigation space throughinfrared light by tracking subsystem 532 via position sensor 540. Thus,the location, orientation, and other information of the targetedanatomical structure is registered in the navigation space. Therefore,registration fixture 1410 may be recognized in both the image spacethrough the use of fiducials 1422 and the navigation space through theuse of markers 1420. At step 1510, the registration of registrationfixture 1410 in the image space is transferred to the navigation space.This transferal is done, for example, by using the relative position ofthe imaging pattern of fiducials 1422 compared to the position of thenavigation pattern of markers 1420.

At step 1512, registration of the navigation space of registrationfixture 1410 (having been registered with the image space) is furthertransferred to the navigation space of dynamic registration array 1404attached to patient fixture instrument 1402. Thus, registration fixture1410 may be removed and dynamic reference base 1404 may be used to trackthe targeted anatomical structure in both the navigation and image spacebecause the navigation space is associated with the image space.

At steps 1514 and 1516, the navigation space may be overlaid on theimage space and objects with markers visible in the navigation space(for example, medical instruments 608 with optical markers 804). Theobjects may be tracked through graphical representations of the medicalinstrument 608 on the images of the targeted anatomical structure.

FIGS. 12A-12B illustrate imaging devices 1304 that may be used inconjunction with robot systems 100, 300, 600 to acquire pre-operative,intra-operative, post-operative, and/or real-time image data of patient210. Any appropriate subject matter may be imaged for any appropriateprocedure using the imaging system 1304. The imaging system 1304 may beany imaging device such as imaging device 1306 and/or a C-arm 1308device. It may be desirable to take x-rays of patient 210 from a numberof different positions, without the need for frequent manualrepositioning of patient 210 which may be required in an x-ray system.As illustrated in FIG. 12A, the imaging system 1304 may be in the formof a C-arm 1308 that includes an elongated C-shaped member terminatingin opposing distal ends 1312 of the “C” shape. C-shaped member 1130 mayfurther comprise an x-ray source 1314 and an image receptor 1316. Thespace within C-arm 1308 of the arm may provide room for the physician toattend to the patient substantially free of interference from x-raysupport structure 1318. As illustrated in FIG. 12B, the imaging systemmay include imaging device 1306 having a gantry housing 1324 attached toa support structure imaging device support structure 1328, such as awheeled mobile cart 1330 with wheels 1332, which may enclose an imagecapturing portion, not illustrated. The image capturing portion mayinclude an x-ray source and/or emission portion and an x-ray receivingand/or image receiving portion, which may be disposed about one hundredand eighty degrees from each other and mounted on a rotor (notillustrated) relative to a track of the image capturing portion. Theimage capturing portion may be operable to rotate three hundred andsixty degrees during image acquisition. The image capturing portion mayrotate around a central point and/or axis, allowing image data ofpatient 210 to be acquired from multiple directions or in multipleplanes. Although certain imaging systems 1304 are exemplified herein, itwill be appreciated that any suitable imaging system may be selected byone of ordinary skill in the art.

Turning now to FIGS. 13A-13C, the medical robot system 100, 300, 600relies on accurate positioning of the end-effector 112, 602, medicalinstruments 608, and/or the patient 210 (e.g., patient tracking device116) relative to the desired medical area. In the embodiments shown inFIGS. 13A-13C, the tracking markers 118, 804 are rigidly attached to aportion of the instrument 608 and/or end-effector 112.

FIG. 13A depicts part of the medical robot system 100 with the robot 102including base 106, robot arm 104, and end-effector 112. The otherelements, not illustrated, such as the display, cameras, etc. may alsobe present as described herein. FIG. 13B depicts a close-up view of theend-effector 112 with guide tube 114 and a plurality of tracking markers118 rigidly affixed to the end-effector 112. In this embodiment, theplurality of tracking markers 118 are attached to the guide tube 112.FIG. 13C depicts an instrument 608 (in this case, a probe 608A) with aplurality of tracking markers 804 rigidly affixed to the instrument 608.As described elsewhere herein, the instrument 608 could include anysuitable medical instrument, such as, but not limited to, guide wire,cannula, a retractor, a drill, a reamer, a screw driver, an insertiontool, a removal tool, or the like.

When tracking an instrument 608, end-effector 112, or other object to betracked in 3D, an array of tracking markers 118, 804 may be rigidlyattached to a portion of the tool 608 or end-effector 112. Preferably,the tracking markers 118, 804 are attached such that the markers 118,804 are out of the way (e.g., not impeding the medical operation,visibility, etc.). The markers 118, 804 may be affixed to the instrument608, end-effector 112, or other object to be tracked, for example, withan array 612. Usually three or four markers 118, 804 are used with anarray 612. The array 612 may include a linear section, a cross piece,and may be asymmetric such that the markers 118, 804 are at differentrelative positions and locations with respect to one another. Forexample, as shown in FIG. 13C, a probe 608A with a 4-marker trackingarray 612 is shown, and FIG. 13B depicts the end-effector 112 with adifferent 4-marker tracking array 612.

In FIG. 13C, the tracking array 612 functions as the handle 620 of theprobe 608A. Thus, the four markers 804 are attached to the handle 620 ofthe probe 608A, which is out of the way of the shaft 622 and tip 624.Stereophotogrammetric tracking of these four markers 804 allows theinstrument 608 to be tracked as a rigid body and for the tracking system100, 300, 600 to precisely determine the position of the tip 624 and theorientation of the shaft 622 while the probe 608A is moved around infront of tracking cameras 200, 326.

To enable automatic tracking of one or more tools 608, end-effector 112,or other object to be tracked in 3D (e.g., multiple rigid bodies), themarkers 118, 804 on each tool 608, end-effector 112, or the like, arearranged asymmetrically with a known inter-marker spacing. The reasonfor asymmetric alignment is so that it is unambiguous which marker 118,804 corresponds to a particular location on the rigid body and whethermarkers 118, 804 are being viewed from the front or back, i.e.,mirrored. For example, if the markers 118, 804 were arranged in a squareon the tool 608 or end-effector 112, it would be unclear to the system100, 300, 600 which markers 118, 804 corresponded to which corner of thesquare. For example, for the probe 608A, it would be unclear whichmarker 804 was closest to the shaft 622. Thus, it would be unknown whichway the shaft 622 was extending from the array 612. Accordingly, eacharray 612 and thus each tool 608, end-effector 112, or other object tobe tracked should have a unique marker pattern to allow it to bedistinguished from other tools 608 or other objects being tracked.Asymmetry and unique marker patterns allow the system 100, 300, 600 todetect individual markers 118, 804 then to check the marker spacingagainst a stored template to determine which tool 608, end effector 112,or other object they represent. Detected markers 118, 804 can then besorted automatically and assigned to each tracked object in the correctorder. Without this information, rigid body calculations could not thenbe performed to extract key geometric information, for example, such astool tip 624 and alignment of the shaft 622, unless the user manuallyspecified which detected marker 118, 804 corresponded to which positionon each rigid body. These concepts are commonly known to those skilledin the methods of 3D optical tracking.

Turning now to FIGS. 14A-14D, an alternative version of an end-effector912 with moveable tracking markers 918A-918D is shown. In FIG. 14A, anarray with moveable tracking markers 918A-918D are shown in a firstconfiguration, and in FIG. 14B the moveable tracking markers 918A-918Dare shown in a second configuration, which is angled relative to thefirst configuration. FIG. 14C shows the template of the tracking markers918A-918D, for example, as seen by the cameras 200, 326 in the firstconfiguration of FIG. 14A; and FIG. 14D shows the template of trackingmarkers 918A-918D, for example, as seen by the cameras 200, 326 in thesecond configuration of FIG. 14B.

In this embodiment, 4-marker array tracking is contemplated wherein themarkers 918A-918D are not all in fixed position relative to the rigidbody and instead, one or more of the array markers 918A-918D can beadjusted, for example, during testing, to give updated information aboutthe rigid body that is being tracked without disrupting the process forautomatic detection and sorting of the tracked markers 918A-918D.

When tracking any tool, such as a guide tube 914 connected to the endeffector 912 of a robot system 100, 300, 600, the tracking array'sprimary purpose is to update the position of the end effector 912 in thecamera coordinate system. When using the rigid system, for example, asshown in FIG. 13B, the array 612 of reflective markers 118 rigidlyextend from the guide tube 114. Because the tracking markers 118 arerigidly connected, knowledge of the marker locations in the cameracoordinate system also provides exact location of the centerline, tip,and tail of the guide tube 114 in the camera coordinate system.Typically, information about the position of the end effector 112 fromsuch an array 612 and information about the location of a targettrajectory from another tracked source are used to calculate therequired moves that must be input for each axis of the robot 102 thatwill move the guide tube 114 into alignment with the trajectory and movethe tip to a particular location along the trajectory vector.

Sometimes, the desired trajectory is in an awkward or unreachablelocation, but if the guide tube 114 could be swiveled, it could bereached. For example, a very steep trajectory pointing away from thebase 106 of the robot 102 might be reachable if the guide tube 114 couldbe swiveled upward beyond the limit of the pitch (wrist up-down angle)axis, but might not be reachable if the guide tube 114 is attachedparallel to the plate connecting it to the end of the wrist. To reachsuch a trajectory, the base 106 of the robot 102 might be moved or adifferent end effector 112 with a different guide tube attachment mightbe exchanged with the working end effector. Both of these solutions maybe time consuming and cumbersome.

As best seen in FIGS. 14A and 14B, if the array 908 is configured suchthat one or more of the markers 918A-918D are not in a fixed positionand instead, one or more of the markers 918A-918D can be adjusted,swiveled, pivoted, or moved, the robot 102 can provide updatedinformation about the object being tracked without disrupting thedetection and tracking process. For example, one of the markers918A-918D may be fixed in position and the other markers 918A-918D maybe moveable; two of the markers 918A-918D may be fixed in position andthe other markers 918A-918D may be moveable; three of the markers918A-918D may be fixed in position and the other marker 918A-918D may bemoveable; or all of the markers 918A-918D may be moveable.

In the embodiment shown in FIGS. 14A and 14B, markers 918A, 918B arerigidly connected directly to a base 906 of the end-effector 912, andmarkers 918C, 918D are rigidly connected to the tube 914. Similar toarray 612, array 908 may be provided to attach the markers 918A-918D tothe end-effector 912, instrument 608, or other object to be tracked. Inthis case, however, the array 908 is comprised of a plurality ofseparate components. For example, markers 918A, 918B may be connected tothe base 906 with a first array 908A, and markers 918C, 918D may beconnected to the guide tube 914 with a second array 908B. Marker 918Amay be affixed to a first end of the first array 908A and marker 918Bmay be separated a linear distance and affixed to a second end of thefirst array 908A. While first array 908 is substantially linear, secondarray 908B has a bent or V-shaped configuration, with respective rootends, connected to the guide tube 914, and diverging therefrom to distalends in a V-shape with marker 918C at one distal end and marker 918D atthe other distal end. Although specific configurations are exemplifiedherein, it will be appreciated that other asymmetric designs includingdifferent numbers and types of arrays 908A, 908B and differentarrangements, numbers, and types of markers 918A-918D are contemplated.

The guide tube 914 may be moveable, swivelable, or pivotable relative tothe base 906, for example, across a hinge 920 or other connector to thebase 906. Thus, markers 918C, 918D are moveable such that when the guidetube 914 pivots, swivels, or moves, markers 918C, 918D also pivot,swivel, or move. As best seen in FIG. 14A, guide tube 914 has alongitudinal axis 916 which is aligned in a substantially normal orvertical orientation such that markers 918A-918D have a firstconfiguration. Turning now to FIG. 14B, the guide tube 914 is pivoted,swiveled, or moved such that the longitudinal axis 916 is now angledrelative to the vertical orientation such that markers 918A-918D have asecond configuration, different from the first configuration.

In contrast to the embodiment described for FIGS. 14A-14D, if a swivelexisted between the guide tube 914 and the arm 104 (e.g., the wristattachment) with all four markers 918A-918D remaining attached rigidlyto the guide tube 914 and this swivel was adjusted by the user, therobotic system 100, 300, 600 would not be able to automatically detectthat the guide tube 914 orientation had changed. The robotic system 100,300, 600 would track the positions of the marker array 908 and wouldcalculate incorrect robot axis moves assuming the guide tube 914 wasattached to the wrist (the robot arm 104) in the previous orientation.By keeping one or more markers 918A-918D (e.g., two markers 918C, 918D)rigidly on the tube 914 and one or more markers 918A-918D (e.g., twomarkers 918A, 918B) across the swivel, automatic detection of the newposition becomes possible and correct robot moves are calculated basedon the detection of a new tool or end-effector 112, 912 on the end ofthe robot arm 104.

One or more of the markers 918A-918D are configured to be moved,pivoted, swiveled, or the like according to any suitable means. Forexample, the markers 918A-918D may be moved by a hinge 920, such as aclamp, spring, lever, slide, toggle, or the like, or any other suitablemechanism for moving the markers 918A-918D individually or incombination, moving the arrays 908A, 908B individually or incombination, moving any portion of the end-effector 912 relative toanother portion, or moving any portion of the tool 608 relative toanother portion.

As shown in FIGS. 14A and 14B, the array 908 and guide tube 914 maybecome reconfigurable by simply loosening the clamp or hinge 920, movingpart of the array 908A, 908B relative to the other part 908A, 908B, andretightening the hinge 920 such that the guide tube 914 is oriented in adifferent position. For example, two markers 918C, 918D may be rigidlyinterconnected with the tube 914 and two markers 918A, 918B may berigidly interconnected across the hinge 920 to the base 906 of theend-effector 912 that attaches to the robot arm 104. The hinge 920 maybe in the form of a clamp, such as a wing nut or the like, which can beloosened and retightened to allow the user to quickly switch between thefirst configuration (FIG. 14A) and the second configuration (FIG. 14B).

The cameras 200, 326 detect the markers 918A-918D, for example, in oneof the templates identified in FIGS. 14C and 14D. If the array 908 is inthe first configuration (FIG. 14A) and tracking cameras 200, 326 detectthe markers 918A-918D, then the tracked markers match Array Template 1as shown in FIG. 14C. If the array 908 is the second configuration (FIG.14B) and tracking cameras 200, 326 detect the same markers 918A-918D,then the tracked markers match Array Template 2 as shown in FIG. 14D.Array Template 1 and Array Template 2 are recognized by the system 100,300, 600 as two distinct tools, each with its own uniquely definedspatial relationship between guide tube 914, markers 918A-918D, androbot attachment. The user could therefore adjust the position of theend-effector 912 between the first and second configurations withoutnotifying the system 100, 300, 600 of the change and the system 100,300, 600 would appropriately adjust the movements of the robot 102 tostay on trajectory.

In this embodiment, there are two assembly positions in which the markerarray matches unique templates that allow the system 100, 300, 600 torecognize the assembly as two different tools or two different endeffectors. In any position of the swivel between or outside of these twopositions (namely, Array Template 1 and Array Template 2 shown in FIGS.14C and 14D, respectively), the markers 918A-918D would not match anytemplate and the system 100, 300, 600 would not detect any array presentdespite individual markers 918A-918D being detected by cameras 200, 326,with the result being the same as if the markers 918A-918D weretemporarily blocked from view of the cameras 200, 326. It will beappreciated that other array templates may exist for otherconfigurations, for example, identifying different instruments 608 orother end-effectors 112, 912, etc.

In the embodiment described, two discrete assembly positions are shownin FIGS. 14A and 14B. It will be appreciated, however, that there couldbe multiple discrete positions on a swivel joint, linear joint,combination of swivel and linear joints, pegboard, or other assemblywhere unique marker templates may be created by adjusting the positionof one or more markers 918A-918D of the array relative to the others,with each discrete position matching a particular template and defininga unique tool 608 or end-effector 112, 912 with different knownattributes. In addition, although exemplified for end effector 912, itwill be appreciated that moveable and fixed markers 918A-918D may beused with any suitable instrument 608 or other object to be tracked.

When using an external 3D tracking system 100, 300, 600 to track a fullrigid body array of three or more markers attached to a robot's endeffector 112 (for example, as depicted in FIGS. 13A and 13B), it ispossible to directly track or to calculate the 3D position of everysection of the robot 102 in the coordinate system of the cameras 200,326. The geometric orientations of joints relative to the tracker areknown by design, and the linear or angular positions of joints are knownfrom encoders for each motor of the robot 102, fully defining the 3Dpositions of all of the moving parts from the end effector 112 to thebase 116. Similarly, if a tracker were mounted on the base 106 of therobot 102 (not shown), it is likewise possible to track or calculate the3D position of every section of the robot 102 from base 106 to endeffector 112 based on known joint geometry and joint positions from eachmotor's encoder.

In some situations, it may be desirable to track the positions of allsegments of the robot 102 from fewer than three markers 118 rigidlyattached to the end effector 112. Specifically, if a tool 608 isintroduced into the guide tube 114, it may be desirable to track fullrigid body motion of the robot 902 with only one additional marker 118being tracked.

Turning now to FIGS. 15A-15E, an alternative version of an end-effector1012 having only a single tracking marker 1018 is shown. End-effector1012 may be similar to the other end-effectors described herein, and mayinclude a guide tube 1014 extending along a longitudinal axis 1016. Asingle tracking marker 1018, similar to the other tracking markersdescribed herein, may be rigidly affixed to the guide tube 1014. Thissingle marker 1018 can serve the purpose of adding missing degrees offreedom to allow full rigid body tracking and/or can serve the purposeof acting as a surveillance marker to ensure that assumptions aboutrobot and camera positioning are valid.

The single tracking marker 1018 may be attached to the robotic endeffector 1012 as a rigid extension to the end effector 1012 thatprotrudes in any convenient direction and does not obstruct the doctor'sview. The tracking marker 1018 may be affixed to the guide tube 1014 orany other suitable location of on the end-effector 1012. When affixed tothe guide tube 1014, the tracking marker 1018 may be positioned at alocation between first and second ends of the guide tube 1014. Forexample, in FIG. 15A, the single tracking marker 1018 is shown as areflective sphere mounted on the end of a narrow shaft 1017 that extendsforward from the guide tube 1014 and is positioned longitudinally abovea mid-point of the guide tube 1014 and below the entry of the guide tube1014. This position allows the marker 1018 to be generally visible bycameras 200, 326 but also would not obstruct vision of the doctor 120 orcollide with other tools or objects in the vicinity of surgery. Inaddition, the guide tube 1014 with the marker 1018 in this position isdesigned for the marker array on any tool 608 introduced into the guidetube 1014 to be visible at the same time as the single marker 1018 onthe guide tube 1014 is visible.

As shown in FIG. 15B, when a snugly fitting tool or instrument 608 isplaced within the guide tube 1014, the instrument 608 becomesmechanically constrained in 4 of 6 degrees of freedom. That is, theinstrument 608 cannot be rotated in any direction except about thelongitudinal axis 1016 of the guide tube 1014 and the instrument 608cannot be translated in any direction except along the longitudinal axis1016 of the guide tube 1014. In other words, the instrument 608 can onlybe translated along and rotated about the centerline of the guide tube1014. If two more parameters are known, such as (1) an angle of rotationabout the longitudinal axis 1016 of the guide tube 1014; and (2) aposition along the guide tube 1014, then the position of the endeffector 1012 in the camera coordinate system becomes fully defined.

Referring now to FIG. 15C, the system 100, 300, 600 should be able toknow when a tool 608 is actually positioned inside of the guide tube1014 and is not instead outside of the guide tube 1014 and justsomewhere in view of the cameras 200, 326. The tool 608 has alongitudinal axis or centerline 616 and an array 612 with a plurality oftracked markers 804. The rigid body calculations may be used todetermine where the centerline 616 of the tool 608 is located in thecamera coordinate system based on the tracked position of the array 612on the tool 608.

The fixed normal (perpendicular) distance DF from the single marker 1018to the centerline or longitudinal axis 1016 of the guide tube 1014 isfixed and is known geometrically, and the position of the single marker1018 can be tracked. Therefore, when a detected distance DD from toolcenterline 616 to single marker 1018 matches the known fixed distance DFfrom the guide tube centerline 1016 to the single marker 1018, it can bedetermined that the tool 608 is either within the guide tube 1014(centerlines 616, 1016 of tool 608 and guide tube 1014 coincident) orhappens to be at some point in the locus of possible positions wherethis distance DD matches the fixed distance DF. For example, in FIG.15C, the normal detected distance DD from tool centerline 616 to thesingle marker 1018 matches the fixed distance DF from guide tubecenterline 1016 to the single marker 1018 in both frames of data(tracked marker coordinates) represented by the transparent tool 608 intwo positions, and thus, additional considerations may be needed todetermine when the tool 608 is located in the guide tube 1014.

Turning now to FIG. 15D, programmed logic can be used to look for framesof tracking data in which the detected distance DD from tool centerline616 to single marker 1018 remains fixed at the correct length despitethe tool 608 moving in space by more than some minimum distance relativeto the single sphere 1018 to satisfy the condition that the tool 608 ismoving within the guide tube 1014. For example, a first frame F1 may bedetected with the tool 608 in a first position and a second frame F2 maybe detected with the tool 608 in a second position (namely, movedlinearly with respect to the first position). The markers 804 on thetool array 612 may move by more than a given amount (e.g., more than 5mm total) from the first frame F1 to the second frame F2. Even with thismovement, the detected distance DD from the tool centerline vector C′ tothe single marker 1018 is substantially identical in both the firstframe F1 and the second frame F2.

Logistically, the doctor 120 or user could place the tool 608 within theguide tube 1014 and slightly rotate it or slide it down into the guidetube 1014 and the system 100, 300, 600 would be able to detect that thetool 608 is within the guide tube 1014 from tracking of the five markers(four markers 804 on tool 608 plus single marker 1018 on guide tube1014). Knowing that the tool 608 is within the guide tube 1014, all 6degrees of freedom may be calculated that define the position andorientation of the robotic end effector 1012 in space. Without thesingle marker 1018, even if it is known with certainty that the tool 608is within the guide tube 1014, it is unknown where the guide tube 1014is located along the tool's centerline vector C′ and how the guide tube1014 is rotated relative to the centerline vector C′.

With emphasis on FIG. 15E, the presence of the single marker 1018 beingtracked as well as the four markers 804 on the tool 608, it is possibleto construct the centerline vector C′ of the guide tube 1014 and tool608 and the normal vector through the single marker 1018 and through thecenterline vector C′. This normal vector has an orientation that is in aknown orientation relative to the forearm of the robot distal to thewrist (in this example, oriented parallel to that segment) andintersects the centerline vector C′ at a specific fixed position. Forconvenience, three mutually orthogonal vectors k′, j′, can beconstructed, as shown in FIG. 15E, defining rigid body position andorientation of the guide tube 1014. One of the three mutually orthogonalvectors k′ is constructed from the centerline vector C′, the secondvector j is constructed from the normal vector through the single marker1018, and the third vector is the vector cross product of the first andsecond vectors k′, j′. The robot's joint positions relative to thesevectors k′, j′, are known and fixed when all joints are at zero, andtherefore rigid body calculations can be used to determine the locationof any section of the robot relative to these vectors k′, j′, when therobot is at a home position. During robot movement, if the positions ofthe tool markers 804 (while the tool 608 is in the guide tube 1014) andthe position of the single marker 1018 are detected from the trackingsystem, and angles/linear positions of each joint are known fromencoders, then position and orientation of any section of the robot canbe determined.

In some embodiments, it may be useful to fix the orientation of the tool608 relative to the guide tube 1014. For example, the end effector guidetube 1014 may be oriented in a particular position about its axis 1016to allow machining or implant positioning. Although the orientation ofanything attached to the tool 608 inserted into the guide tube 1014 isknown from the tracked markers 804 on the tool 608, the rotationalorientation of the guide tube 1014 itself in the camera coordinatesystem is unknown without the additional tracking marker 1018 (ormultiple tracking markers in other embodiments) on the guide tube 1014.This marker 1018 provides essentially a “clock position” from −180° to+180° based on the orientation of the marker 1018 relative to thecenterline vector C′. Thus, the single marker 1018 can provideadditional degrees of freedom to allow full rigid body tracking and/orcan act as a surveillance marker to ensure that assumptions about therobot and camera positioning are valid.

FIG. 16 is a block diagram of a method 1100 for navigating and movingthe end-effector 1012 (or any other end-effector described herein) ofthe robot 102 to a desired target trajectory. Another use of the singlemarker 1018 on the robotic end effector 1012 or guide tube 1014 is aspart of the method 1100 enabling the automated safe movement of therobot 102 without a full tracking array attached to the robot 102. Thismethod 1100 functions when the tracking cameras 200, 326 do not moverelative to the robot 102 (i.e., they are in a fixed position), thetracking system's coordinate system and robot's coordinate system areco-registered, and the robot 102 is calibrated such that the positionand orientation of the guide tube 1014 can be accurately determined inthe robot's Cartesian coordinate system based only on the encodedpositions of each robotic axis.

For this method 1100, the coordinate systems of the tracker and therobot must be co-registered, meaning that the coordinate transformationfrom the tracking system's Cartesian coordinate system to the robot'sCartesian coordinate system is needed. For convenience, this coordinatetransformation can be a 4×4 matrix of translations and rotations that iswell known in the field of robotics. This transformation will be termedTcr to refer to “transformation—camera to robot”. Once thistransformation is known, any new frame of tracking data, which isreceived as x,y,z coordinates in vector form for each tracked marker,can be multiplied by the 4×4 matrix and the resulting x,y,z coordinateswill be in the robot's coordinate system. To obtain Tcr, a full trackingarray on the robot is tracked while it is rigidly attached to the robotat a location that is known in the robot's coordinate system, then knownrigid body methods are used to calculate the transformation ofcoordinates. It should be evident that any tool 608 inserted into theguide tube 1014 of the robot 102 can provide the same rigid bodyinformation as a rigidly attached array when the additional marker 1018is also read. That is, the tool 608 need only be inserted to anyposition within the guide tube 1014 and at any rotation within the guidetube 1014, not to a fixed position and orientation. Thus, it is possibleto determine Tcr by inserting any tool 608 with a tracking array 612into the guide tube 1014 and reading the tool's array 612 plus thesingle marker 1018 of the guide tube 1014 while at the same timedetermining from the encoders on each axis the current location of theguide tube 1014 in the robot's coordinate system.

Logic for navigating and moving the robot 102 to a target trajectory isprovided in the method 1100 of FIG. 16. Before entering the loop 1102,it is assumed that the transformation Tcr was previously stored. Thus,before entering loop 1102, in step 1104, after the robot base 106 issecured, greater than or equal to one frame of tracking data of a toolinserted in the guide tube while the robot is static is stored; and instep 1106, the transformation of robot guide tube position from cameracoordinates to robot coordinates Tcr is calculated from this static dataand previous calibration data. Tcr should remain valid as long as thecameras 200, 326 do not move relative to the robot 102. If the cameras200, 326 move relative to the robot 102, and Tcr needs to bere-obtained, the system 100, 300, 600 can be made to prompt the user toinsert a tool 608 into the guide tube 1014 and then automaticallyperform the necessary calculations.

In the flowchart of method 1100, each frame of data collected consistsof the tracked position of the DRB 1404 on the patient 210, the trackedposition of the single marker 1018 on the end effector 1014, and asnapshot of the positions of each robotic axis. From the positions ofthe robot's axes, the location of the single marker 1018 on the endeffector 1012 is calculated. This calculated position is compared to theactual position of the marker 1018 as recorded from the tracking system.If the values agree, it can be assured that the robot 102 is in a knownlocation. The transformation Tcr is applied to the tracked position ofthe DRB 1404 so that the target for the robot 102 can be provided interms of the robot's coordinate system. The robot 102 can then becommanded to move to reach the target.

After steps 1104, 1106, loop 1102 includes step 1108 receiving rigidbody information for DRB 1404 from the tracking system; step 1110transforming target tip and trajectory from image coordinates totracking system coordinates; and step 1112 transforming target tip andtrajectory from camera coordinates to robot coordinates (apply Tcr).Loop 1102 further includes step 1114 receiving a single stray markerposition for robot from tracking system; and step 1116 transforming thesingle stray marker from tracking system coordinates to robotcoordinates (apply stored Tcr). Loop 1102 also includes step 1118determining current location of the single robot marker 1018 in therobot coordinate system from forward kinematics. The information fromsteps 1116 and 1118 is used to determine step 1120 whether the straymarker coordinates from transformed tracked position agree with thecalculated coordinates being less than a given tolerance. If yes,proceed to step 1122, calculate and apply robot move to target x, y, zand trajectory. If no, proceed to step 1124, halt and require full arrayinsertion into guide tube 1014 before proceeding; step 1126 after arrayis inserted, recalculate Tcr; and then proceed to repeat steps 1108,1114, and 1118.

This method 1100 has advantages over a method in which the continuousmonitoring of the single marker 1018 to verify the location is omitted.Without the single marker 1018, it would still be possible to determinethe position of the end effector 1012 using Tcr and to send theend-effector 1012 to a target location but it would not be possible toverify that the robot 102 was actually in the expected location. Forexample, if the cameras 200, 326 had been bumped and Tcr was no longervalid, the robot 102 would move to an erroneous location. For thisreason, the single marker 1018 provides value with regard to safety.

For a given fixed position of the robot 102, it is theoreticallypossible to move the tracking cameras 200, 326 to a new location inwhich the single tracked marker 1018 remains unmoved since it is asingle point, not an array. In such a case, the system 100, 300, 600would not detect any error since there would be agreement in thecalculated and tracked locations of the single marker 1018. However,once the robot's axes caused the guide tube 1012 to move to a newlocation, the calculated and tracked positions would disagree and thesafety check would be effective.

The term “surveillance marker” may be used, for example, in reference toa single marker that is in a fixed location relative to the DRB 1404. Inthis instance, if the DRB 1404 is bumped or otherwise dislodged, therelative location of the surveillance marker changes and the doctor 120can be alerted that there may be a problem with navigation. Similarly,in the embodiments described herein, with a single marker 1018 on therobot's guide tube 1014, the system 100, 300, 600 can continuously checkwhether the cameras 200, 326 have moved relative to the robot 102. Ifregistration of the tracking system's coordinate system to the robot'scoordinate system is lost, such as by cameras 200, 326 being bumped ormalfunctioning or by the robot malfunctioning, the system 100, 300, 600can alert the user and corrections can be made. Thus, this single marker1018 can also be thought of as a surveillance marker for the robot 102.

It should be clear that with a full array permanently mounted on therobot 102 (e.g., the plurality of tracking markers 702 on end-effector602 shown in FIGS. 7A-7C) such functionality of a single marker 1018 asa robot surveillance marker is not needed because it is not requiredthat the cameras 200, 326 be in a fixed position relative to the robot102, and Tcr is updated at each frame based on the tracked position ofthe robot 102. Reasons to use a single marker 1018 instead of a fullarray are that the full array is more bulky and obtrusive, therebyblocking the doctor's view and access to the medical field 208 more thana single marker 1018, and line of sight to a full array is more easilyblocked than line of sight to a single marker 1018.

Turning now to FIGS. 17A-17B and 18A-18B, instruments 608, such asimplant holders 608B, 608C, are depicted which include both fixed andmoveable tracking markers 804, 806. The implant holders 608B, 608C mayhave a handle 620 and an outer shaft 622 extending from the handle 620.The shaft 622 may be positioned substantially perpendicular to thehandle 620, as shown, or in any other suitable orientation. An innershaft 626 may extend through the outer shaft 622 with a knob 628 at oneend. Implant 10, 12 connects to the shaft 622, at the other end, at tip624 of the implant holder 608B, 608C using typical connection mechanismsknown to those of skill in the art. The knob 628 may be rotated, forexample, to expand or articulate the implant 10, 12. U.S. Pat. Nos.8,709,086 and 8,491,659, which are incorporated by reference herein,describe expandable fusion devices and methods of installation.

When tracking the tool 608, such as implant holder 608B, 608C, thetracking array 612 may contain a combination of fixed markers 804 andone or more moveable markers 806 which make up the array 612 or isotherwise attached to the implant holder 608B, 608C. The navigationarray 612 may include at least one or more (e.g., at least two) fixedposition markers 804, which are positioned with a known locationrelative to the implant holder instrument 608B, 608C. These fixedmarkers 804 would not be able to move in any orientation relative to theinstrument geometry and would be useful in defining where the instrument608 is in space. In addition, at least one marker 806 is present whichcan be attached to the array 612 or the instrument itself which iscapable of moving within a pre-determined boundary (e.g., sliding,rotating, etc.) relative to the fixed markers 804. The system 100, 300,600 (e.g., the software) correlates the position of the moveable marker806 to a particular position, orientation, or other attribute of theimplant 10 (such as height of an expandable interbody spacer shown inFIGS. 17A-17B or angle of an articulating interbody spacer shown inFIGS. 18A-18B). Thus, the system and/or the user can determine theheight or angle of the implant 10, 12 based on the location of themoveable marker 806.

In the embodiment shown in FIGS. 17A-17B, four fixed markers 804 areused to define the implant holder 608B and a fifth moveable marker 806is able to slide within a pre-determined path to provide feedback on theimplant height (e.g., a contracted position or an expanded position).FIG. 17A shows the expandable spacer 10 at its initial height, and FIG.17B shows the spacer 10 in the expanded state with the moveable marker806 translated to a different position. In this case, the moveablemarker 806 moves closer to the fixed markers 804 when the implant 10 isexpanded, although it is contemplated that this movement may be reversedor otherwise different. The amount of linear translation of the marker806 would correspond to the height of the implant 10. Although only twopositions are shown, it would be possible to have this as a continuousfunction whereby any given expansion height could be correlated to aspecific position of the moveable marker 806.

Turning now to FIGS. 18A-18B, four fixed markers 804 are used to definethe implant holder 608C and a fifth, moveable marker 806 is configuredto slide within a pre-determined path to provide feedback on the implantarticulation angle. FIG. 18A shows the articulating spacer 12 at itsinitial linear state, and FIG. 18B shows the spacer 12 in an articulatedstate at some offset angle with the moveable marker 806 translated to adifferent position. The amount of linear translation of the marker 806would correspond to the articulation angle of the implant 12. Althoughonly two positions are shown, it would be possible to have this as acontinuous function whereby any given articulation angle could becorrelated to a specific position of the moveable marker 806.

In these embodiments, the moveable marker 806 slides continuously toprovide feedback about an attribute of the implant 10, 12 based onposition. It is also contemplated that there may be discreet positionsthat the moveable marker 806 must be in which would also be able toprovide further information about an implant attribute. In this case,each discreet configuration of all markers 804, 806 correlates to aspecific geometry of the implant holder 608B, 608C and the implant 10,12 in a specific orientation or at a specific height. In addition, anymotion of the moveable marker 806 could be used for other variableattributes of any other type of navigated implant.

Although depicted and described with respect to linear movement of themoveable marker 806, the moveable marker 806 should not be limited tojust sliding as there may be applications where rotation of the marker806 or other movements could be useful to provide information about theimplant 10, 12. Any relative change in position between the set of fixedmarkers 804 and the moveable marker 806 could be relevant informationfor the implant 10, 12 or other device. In addition, although expandableand articulating implants 10, 12 are exemplified, the instrument 608could work with other medical devices and materials, such as spacers,cages, plates, fasteners, nails, screws, rods, pins, wire structures,sutures, anchor clips, staples, stents, bone grafts, biologics, cements,or the like.

Turning now to FIG. 19A, it is envisioned that the robot end-effector112 is interchangeable with other types of end-effectors 112. Moreover,it is contemplated that each end-effector 112 may be able to perform oneor more functions based on a desired medical procedure. For example, theend-effector 112 having a guide tube 114 may be used for guiding aninstrument 608 as described herein. In addition, end-effector 112 may bereplaced with a different or alternative end-effector 112 that controlsa medical device, instrument, or implant, for example.

The alternative end-effector 112 may include one or more devices orinstruments coupled to and controllable by the robot. By way ofnon-limiting example, the end-effector 112, as depicted in FIG. 19A, maycomprise a retractor (for example, one or more retractors disclosed inU.S. Pat. Nos. 8,992,425 and 8,968,363) or one or more mechanisms forinserting or installing medical devices such as expandableintervertebral fusion devices (such as expandable implants exemplifiedin U.S. Pat. Nos. 8,845,734; 9,510,954; and 9,456,903), stand-aloneintervertebral fusion devices (such as implants exemplified in U.S. Pat.Nos. 9,364,343 and 9,480,579), expandable corpectomy devices (such ascorpectomy implants exemplified in U.S. Pat. Nos. 9,393,128 and9,173,747), articulating spacers (such as implants exemplified in U.S.Pat. No. 9,259,327), facet prostheses (such as devices exemplified inU.S. Pat. No. 9,539,031), laminoplasty devices (such as devicesexemplified in U.S. Pat. No. 9,486,253), spinous process spacers (suchas implants exemplified in U.S. Pat. No. 9,592,082), inflatables,fasteners including polyaxial screws, uniplanar screws, pedicle screws,posted screws, and the like, bone fixation plates, rod constructs andrevision devices (such as devices exemplified in U.S. Pat. No.8,882,803), artificial and natural discs, motion preserving devices andimplants, spinal cord stimulators (such as devices exemplified in U.S.Pat. No. 9,440,076), and other medical devices. The end-effector 112 mayinclude one or instruments directly or indirectly coupled to the robotfor providing bone cement, bone grafts, living cells, pharmaceuticals,or other deliverable to a medical target. The end-effector 112 may alsoinclude one or more instruments designed for performing a discectomy,kyphoplasty, vertebrostenting, dilation, or other medical procedure.

The end-effector itself and/or the implant, device, or instrument mayinclude one or more markers 118 such that the location and position ofthe markers 118 may be identified in three-dimensions. It iscontemplated that the markers 118 may include active or passive markers118, as described herein, that may be directly or indirectly visible tothe cameras 200. Thus, one or more markers 118 located on an implant 10,for example, may provide for tracking of the implant 10 before, during,and after implantation.

As shown in FIG. 19B, the end-effector 112 may include an instrument 608or portion thereof that is coupled to the robot arm 104 (for example,the instrument 608 may be coupled to the robot arm 104 by the couplingmechanism shown in FIGS. 9A-9C) and is controllable by the robot system100. Thus, in the embodiment shown in FIG. 19B, the robot system 100 isable to insert implant 10 into a patient and expand or contract theexpandable implant 10. Accordingly, the robot system 100 may beconfigured to assist a doctor or to operate partially or completelyindependently thereof. Thus, it is envisioned that the robot system 100may be capable of controlling each alternative end-effector 112 for itsspecified function or medical procedure.

Although the robot and associated systems described herein are generallydescribed with reference to spine applications, it is also contemplatedthat the robot system may be configured for use in other medicalapplications, including but not limited to, medical imaging, surgeriesin trauma or other orthopedic applications (such as the placement ofintramedullary nails, plates, and the like), cranial, neuro,cardiothoracic, vascular, colorectal, oncological, dental, and othermedical operations and procedures.

During robotic spine (or other) procedures, a Dynamic Reference Base(DRB) may thus be affixed to the patient (e.g., to a bone of thepatient), and used to track the patient anatomy. Since the patient isbreathing, a position of the DRB (which is attached to the patient'sbody) may oscillate. Once a medical tool is robotically moved to atarget trajectory and locked into position, patient movement (e.g., dueto breathing) may cause deviation from the target trajectory eventhrough the end-effector (e.g., medical tool) is locked in place. Thisdeviation/shift (if unnoticed and unaccounted for) may thus reduceaccuracy of the system and/or medical procedure.

Elements of robotic systems discussed above may be used to adjustplacement of a virtual implant according to some embodiments ofinventive concepts. By using navigated tools to plan instrument andimplant trajectories, surgeons can have a more user-friendly system andmore flexibility when planning robotic or navigated surgical cases.Setting the offset along a planned trajectory may allow individualsfamiliar with surgical navigation to pick up robotic surgery morequickly, and allow more flexibility for all users in planninginterventions. The system can offer surgeons greater flexibility becausethe motions performed in moving the probe to position the virtualimplant may mimic the motions of a surgery to be performed to implant aphysical implant in a body. The system can also make planning implantswith correct offsets easier and better leverage the perspective of thesurgeon.

FIG. 20 is a block diagram illustrating elements of a controller 2000(e.g., implemented within computer 408) for a robotic navigation system(also referred to as an imaging system or a surgical navigation system).As shown, controller 2000 may include processor circuit 2007 (alsoreferred to as a processor) coupled with input interface circuit 2001(also referred to as an input interface), output interface circuit 2003(also referred to as an output interface), control interface circuit2005 (also referred to as a control interface, and memory circuit 2009(also referred to as a memory). The memory circuit 2009 may includecomputer readable program code that when executed by the processorcircuit 2007 causes the processor circuit to perform operationsaccording to embodiments disclosed herein. According to otherembodiments, processor circuit 2007 may be defined to include memory sothat a separate memory circuit is not required.

As discussed herein, operations of navigation system controller 2000(e.g., a robotic navigation system controller) may be performed byprocessor 2007, input interface 2001, output interface 2003, and/orcontrol interface 2005. For example, processor 2007 may receive userinput through input interface 2001, and such user input may include userinput received through a keyboard, mouse, touch sensitive display, footpedal 544, tablet 546, etc. Processor 2007 may also receive positionsensor input from tracking system 532 and/or cameras 200 through inputinterface 2001. Processor 2007 may provide output through outputinterface 2003, and such output may include information to rendergraphic/visual information on display 304 and/or audio output to beprovided through speaker 536. Processor 2007 may provide robotic controlinformation through control interface 2005 to motion control subsystem506, and the robotic control information may be used to controloperation of robot arm 104 or other robotic actuators. Processor 2007may also receive feedback information through control interface 2005.

FIG. 21 depicts an example of a surgical navigation system used toadjust placement of a virtual implant 2120 in response to movement of aprobe 2110. In this example, the surgical navigation system includessensors 2160, which can capture movement of at a probe 2110 with a tip2112 in relation to a body 2150. The sensors 2160 can include cameras200, the probe 2110 can include navigated instrument 608, and the body2150 can include patient 210. The sensors 2160 can detect trackingmarkers 2111 attached to the probe 2110 and determine positional datafor the probe 2110 based on the position of the tracking markers 2111.The surgical navigation system can determine a trajectory 2140 based onan orientation of the probe 2110 and can determine a position of avirtual implant 2120 based on an offset 2130 from the tip 2112 along thetrajectory 2140.

In some embodiments, the probe 2110 can be a physical device that ispositioned adjacent to the body 2150, which can include a human body.The surgical navigation system can use 3D anatomical image informationto generate an image of the body 2150 that can include the virtualimplant 2120. The image including the virtual implant 2120 can bedisplayed on a monitor and updated such that moving the probe 2110adjacent to the body 2150 can cause a virtual implementation of theprobe 2110, trajectory 2140, or the virtual implant 2120 to move on theimage displayed. In some examples, the system can track the probe 2110,and on a first press of a button (e.g., a foot pedal) set the trajectory2112 and determine a placement for the virtual implant 2120 at a defaultoffset along the trajectory 2140. Holding the button can allow forfurther adjustment of the offset 2130 along the trajectory 2140.Adjustments to the offset 2130 can be calculated in several ways.

In some embodiments, the position of the tip 2112 of the probe 2110 canbe used to determine the position of the virtual implant 2120 along thetrajectory 2140. In additional or alternative embodiments, the positionof the virtual implant 2120 can be adjusted based on detecting arotation of the probe 2110.

For purposes of illustration, FIG. 21 mixes physical elements (directlyvisible to a user) and virtual elements (that are only visible on adisplay). In particular, a surface of body 2150 and/or the physicalprobe 2110 may be visible to the user and sensor 2160, but internalportions of the body and the virtual implant are not directly visible.Instead, the surgical navigation system may render a two dimensionalimage on a display, with the two dimensional image including internalportions of body 2150, virtual implant 2120, the surface of body 2150,and probe 2110.

Examples of a telescoping version of the probe 2110 are depicted inFIGS. 23A-B. The same probe 2110 is depicted in both FIGS. 23A and 23B.The probe includes a thumb wheel 2310 that may be turned to adjust alength of the probe 2110. By turning the thumb wheel 2310 in FIG. 23Aclockwise the telescoping shaft 2320 retracts upon itself and shortensto the length of the telescoping shaft 2320 in FIG. 23B. In someembodiments, processor 2007 can be provided with positional data for thetracking markers 2111 and a default length of the tip 2112 from thetracking markers 2111. The processor 2007 can determine the position ofthe virtual implant 2120 based on the positional data for the trackingmarkers 2111 and the default length such that if a user adjusts theactual length of the probe 2110 while maintaining the position of thetip 2112 processor 2007 can adjust the position of the virtual implant.For example, if a user shortens a probe 2110 using the thumb wheel 2310while maintaining the position of the tip 2112, the processor 2007 willcalculate the position of the tip 2112 to be closer (or farther within)the anatomical body 2150 than it is and cause the position of thevirtual implant 2120 to be adjusted to be farther into the body 2150.

Although FIGS. 23A-B depict a telescoping version of the probe 2110 witha thumb wheel 2310, other mechanisms can be used to adjust the length ofthe probe 2110. The probe 2110 is explained with more detail in regardsto the medical instrument in FIGS. 13A-C above.

Operations of a navigation system (e.g., a robotic navigation systemthat includes a robotic actuator configured to position a probe on abody) will now be discussed with reference to the flow chart of FIG. 22according to some embodiments of inventive concepts. For example,modules may be stored in memory 2009 of FIG. 20, and these modules mayprovide instructions so that when the instructions of a module areexecuted by processor 2007, processor 2007 performs respectiveoperations of the flow chart of FIG. 22.

FIG. 22 depicts an example of operations performed by a navigationsystem using 3D imaging information for a 3D anatomical volume todetermine a position for a virtual implant.

At block 2210, processor 2007 may provide 3D imaging information for a3D anatomical volume (e.g., the body 2150). At block 2220, processor2007 may detect a pose of the probe 2110. The pose of the probe 2110 caninclude the position and/or the orientation of the probe 2110. In someembodiments, processor 2007 may detect the pose based on informationreceived from a positioning system (also referred to as a trackingsystem). For example, the probe 2110 may include one or more spacedapart tracking markers 2111 and the positioning system may detect theposition and orientation of the probe 2110 by detecting the trackingmarkers 2111. The processor 2007 can receive position data ororientation data from the positioning system via input interface 2001.

At block 2230, processor 2007 may determine a placement of the virtualimplant 2120 for the 3D anatomical volume based on the pose of the probe2110 and based on a default offset from an end of the probe 2110 alongthe longitudinal axis. The virtual implant 2120 can be overlaid on animage from the 3D anatomical volume such that the trajectory 2140 of thevirtual implant 2120 is in alignment with the longitudinal axis of theprobe in the orientation.

At block 2240, processor 2007 may provide reformatted image data viaoutput interface 2003. The reformatted image data can be based on the 3Danatomical imaging information. In some embodiments, processor 2007provides first reformatted image data to be rendered on a display (e.g.,display 110) based on the 3D anatomical imaging information and based onthe placement of the virtual implant. The 3-dimensional information caninclude the position and orientation or trajectory of the virtualimplant 2120.

In additional or alternative embodiments, processor 2007 may provide newimage data via output interface 2003. The new image data can be based onnewly captured 3D anatomical imaging data and based on the placement ofthe virtual implant.

If processor 2007 has not received user input indicating a desire toadjust the virtual implant 2120, at block 2245 the processor 2007 maydecide to repeat blocks 2220, 2230, and 2240. The image may becontinuously updated and displayed on a display visible to a user suchthat the user can see changes in a position and trajectory of thevirtual implant 2120 in response to movement of the probe 2110. If userinput indicating a desire to adjust the virtual implant 2120 has beenreceived, the processor 2007 may decide at block 2245 to proceed toblock 2250. In some embodiments, processor 2007 can receive a signalfrom a button/pedal pressed by a user to indicate a desire to adjust thevirtual implant 2120. In additional or alternative embodiments,processor 2007 can receive position data for the probe 2110 indicatingthe probe has moved in a predefined way so as to indicate a desire toadjust the virtual implant 2120. In additional or alternativeembodiments, processor 2007 can receive user input from an input device(e.g., a keyboard or mouse) indicating a desire to adjust the virtualimplant 2120.

At block 2250, processor 2007 adjusts the virtual implant 2120. In someembodiments, the processor 2007 adjusts the virtual implant 2120 afterdetermining the placement of the virtual implant 2120 in block 2230 inresponse to movement of the probe 2110. The placement of the virtualimplant 2120 can be adjusted while maintaining the trajectory 2140 ofthe virtual implant 2120. The processor 2007 may move the placement ofthe virtual implant 2120 along the trajectory 2140 responsive tomovement of the probe 2110.

In some embodiments, processor 2007 can move the virtual implant 2120 ina first direction along the trajectory 2140 in response to detectingrotation of the probe 2110 in a first rotational direction and move thevirtual implant 2120 in a second direction along the trajectory 2140 inresponse to detecting rotation of the probe in a second rotationaldirection. Such adjustment is discussed in greater detail with respectto FIG. 25.

In additional or alternative embodiments, moving the virtual implant2120 can include moving the virtual implant along the trajectory 2140responsive to detecting movement of the tip 2112 of the probe 2110 in adirection that is nonparallel with respect to the trajectory 2140 of thevirtual implant 2120. In additional or alternative embodiments, movingthe virtual implant 2120 can include moving the virtual implant 2120 ina first direction along the trajectory 2140 in response to detectingmovement of the tip 2112 of the probe 2110 away from the trajectory 2140of the virtual implant 2120 and moving the virtual implant 2120 in asecond direction along the trajectory 2140 in response to detectingmovement of the tip 2112 of the probe 2110 toward the trajectory 2140.Such adjustment is discussed in greater detail below with respect toFIGS. 24A and 24B.

In additional or alternative embodiments, moving the virtual implant2120 can include moving the virtual implant 2120 along the trajectory2140 in response to detecting movement of the tip 2112 of the probearound the trajectory 2140 of the virtual implant. The virtual implant2120 can be moved in a first direction along the trajectory in responseto detecting movement of the tip 2112 of the probe 2110 in a clockwisedirection around the trajectory 2140 and can be moved in a seconddirection along the trajectory 2140 in response to detecting movement ofthe tip 2112 of the probe 2110 in a counter-clockwise direction aroundthe trajectory 2140. The scale of movement of the virtual implant 2120along the trajectory 2140 can be relative to movement of the tip 2112based on a distance of the tip from the trajectory 2140. Such adjustmentis discussed in greater detail below with respect to FIG. 26.

FIGS. 24A-B depict an example of how a position of the tip 2112 of theprobe 2110 can be used to adjust a position of the virtual implant 2120along the trajectory 2140. In regards to FIG. 24A, processor 2007 canuse position data of the tip 2112 of the probe 2110 to determine aninitial position 2444 of the tip 2112, which may be on the trajectory2140. An offset 2130 of the virtual implant 2120 from the initialposition 2444 can be set to a default offset that extends into the 3Danatomical volume (body 2150 in this example). FIG. 24B depicts theprobe 2110 in another position relative to the body 2150. As probe 2110moves, processor 2007 can determine a closest corresponding point 2442along the trajectory to the tip 2112. Processor 2007 can furtherdetermine a distance 2420 between the closest corresponding point 2442and the initial position 2444 of the tip 2112. Distance 2420 can be usedto set the offset 2130 of the virtual implant 2120, while maintainingthe additional constraint that the virtual implant 2120 remain orientedalong the trajectory 2140. In this example, as the closest point 2442moves away from the position of the virtual implant 2120, the offset maybe reduced, and as the closest point 2442 moves toward the position ofthe virtual implant 2120 the offset may be increased. The amount thatthe offset is adjusted may be proportional to the change in the distance2420 between the closest point 2442 and the initial position 2444.

In additional or alternative embodiments, processor 2007 can adjust theoffset 2130 by determining the distance 2410 between the initialposition 2444 of the tip 2112 and the current location of the tip 2112.The closest point 2442 may remain the same while the offset is adjustedbased on changes in the distance 2410. The offset 2130 can be based on acombination of distance 2420 and distance 2410.

FIG. 25 depicts an example of how a rotation of the probe 2110 about alongitudinal axis of the probe 2110 can be used to adjust a position ofthe virtual implant 2120 along the trajectory 2140. In some embodiments,processor 2007 can adjust a position of the virtual implant 2120 basedon rotation of the probe 2110 without the probe 2110 moving along thetrajectory 2140, which can be useful when the probe is bottomed on apedicle or already in contact with a body. In some examples, processor2007 can advance (e.g., move farther into a virtual body) a position ofa virtual implant 2120 along a trajectory 2140 in response to detectinga clockwise rotation of the probe 2110 about the longitudinal axis ofthe probe 2110. The processor 2007 can retreat (e.g., move closer to asurface of the virtual body) a position of a virtual implant 2120 alonga trajectory 2140 in response to detecting a counter-clockwise rotationof the probe 2110 about the longitudinal axis of the probe 2110. Inadditional or alternative embodiments, the speed of the movement orrotation of the probe 2110 can be determined by the probe 2110 and usedto determine a direction that the virtual implant 2120 should beadjusted. For example, the probe 2110 may be quickly rotatedcounter-clockwise and then slowly rotated counter-clockwise andprocessor 2007 may detect this series of movements to indicate that theclockwise rotation should be used to increase the offset of the virtualimplant 2120 and that the counter-clockwise rotation should be ignored(e.g., similar to a ratcheting action). In additional or alternativeembodiments, the probe 2110 may be rendered as a virtual tap or othervirtual surgical instrument or implant corresponding most closely to theimplant-instrument combination that may be used in a subsequent surgery.

FIG. 26 depicts an example of how a rotation of the probe 2110 tip 2112around the trajectory 2140 can be used to adjust a position of thevirtual implant 2120 along the trajectory 2140. In some embodiments, thetip 2112 of the probe 2110 can be used to define a lever arm from theprobe 2110 to a point 2620 on the trajectory 2140. Processor 2007 candetermine a length of the lever arm based on a distance between the tip2112 and the point 2620 and an angle of the lever arm based on thecurrent orientation of the probe 2110 compared to a plane perpendicularto the trajectory 2140 that includes the point 2620. Processor 2007 canadjust the placement of the virtual implant 2120 based on detecting auser rotating or cranking the top of the probe 2110 about the trajectory2140. The length and angle of the lever arm can affect the offsetscaling. For example, lengthening the lever arm may reduce the amount ofadjustment that is made to the position of the virtual implant 2120 perrotation of the probe 2110 about the trajectory 2140.

In some embodiments, processor 2007 can implement a ratcheting systemsuch that adjustments to the position of the virtual implant 2120 areonly made in response to rotation of the probe 2110 in one direction.For example, the processor 2007 may only adjust the offset of thevirtual implant 2120 in response to detecting clockwise rotation of theprobe 2110 allowing a user to adjust the virtual implant 2120 farther ina single direction along the trajectory 2140 while maintaining a smallworking envelope or with greater precision.

Any of the examples in FIGS. 24-26 can be combined to adjust theplacement of the virtual implant 2120. In any of the embodiments, theratio of user motion to offset adjustment can be scaled. The scaling maybe informed by the position and orientation of the navigated instrument.For example, the processor 2007 can change the scaling when using arotational mode based on changing the pitch of the probe 2110 or adistance between a point on the probe 2110 and a point on the trajectory2140.

Returning to block 2250 of FIG. 22, in some embodiments, processor 2007can adjust the virtual implant responsive to movement of the probe andresponsive to user input separate from the movement of the probe whilemaintaining the trajectory of the virtual implant. For example, the userinput may include depression of a button or pedal communicativelycoupled to the navigation system.

In additional or alternative embodiments, adjusting the virtual implant2120 can include changing a size of the virtual implant 2120 responsiveto movement of the probe 2110 while maintaining the trajectory 2140 ofthe virtual implant as discussed above with respect to FIGS. 24-26. Forexample, processor 2007 can adjust a length or width of the virtualimplant 2120 in response to rotation of the probe 2110. The virtualimplant 2120 may be a virtual screw or any other suitable virtualimplant.

At block 2260, processor 2007 provides the reformatted image data viaoutput interface 2003. In some embodiments, processor 2007 providessecond reformatted image data to be rendered on a display based onadjusting the virtual implant 2120. The second reformatted image datamay be different than the first reformatted image data provided in block2240. For example, since the trajectory 2140 is not changing, the secondreformatted image data may not include trajectory data or else thetransmitted trajectory data will remain constant while the virtualimplant data changes. The first reformatted image data may not includevirtual implant data or may include constant virtual implant data suchas a default offset and default size or shape of the virtual implant2120. In some embodiments, the first image may include a portion thebody 2150 with a first marked location and first orientation of thevirtual implant 2120 and the second image may include the portion of thebody 2150 with a second marked location and second orientation of thevirtual implant 2120. The second marked location may be shallower thanthe first marked location. The first image may further include a firstdepiction of the virtual implant 2120 as a particular type of implantwith a particular size and the second image may include a seconddepiction of the virtual implant 2120 having a different type or adifferent size.

If processor 2007 has not received user input indicating a desire tostore the virtual implant data, the processor 2007 may decide at block2265 to repeat blocks 2250 and 2260. If processor 2007 receives userinput indicating a desire to store the virtual implant data, theprocessor 2007 may determine at block 2265 to proceed to block 2270.

At block 2270, processor 2007 stores the virtual implant data. In someembodiments, the reformatted image data can be stored in response touser input. The reformatted image data may include a position,trajectory, size, shape, and type of the virtual implant 2120. In someexamples, the virtual implant may be adjusted while a user depresses abutton or a pedal (as discussed above) and the processor 2007 may storethe information regarding the virtual implant in response to release ofthe button or pedal. In other embodiments, a first button/pedal may beused to initiate adjustment, and a second button/peal may be used tostore the virtual implant data.

At block 2280, processor 2007 controls a robotic actuator. In someembodiments, processor 2007 can control a robotic actuator via controlinterface 2005 to position an end-effector based on the informationregarding the virtual implant. For example, the processor 2007 cancontrol a robotic actuator to position an end-effector such that asurgical operation can be performed using the end-effector to place aphysical implant at a position in a body based on the informationregarding the virtual implant 2120. In additional or alternativeembodiments, processor 2007 can control the robotic actuator to performthe surgical operation and place a physical implant in the body based onthe information regarding the virtual implant 2120.

In the above-description of various embodiments of present inventiveconcepts, it is to be understood that the terminology used herein is forthe purpose of describing particular embodiments only and is notintended to be limiting of present inventive concepts. Unless otherwisedefined, all terms (including technical and scientific terms) usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which present inventive concepts belong. It will befurther understood that terms, such as those defined in commonly useddictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of this specification andthe relevant art and will not be interpreted in an idealized or overlyformal sense unless expressly so defined herein.

When an element is referred to as being “connected”, “coupled”,“responsive”, or variants thereof to another element, it can be directlyconnected, coupled, or responsive to the other element or interveningelements may be present. In contrast, when an element is referred to asbeing “directly connected”, “directly coupled”, “directly responsive”,or variants thereof to another element, there are no interveningelements present. Like numbers refer to like elements throughout.Furthermore, “coupled”, “connected”, “responsive”, or variants thereofas used herein may include wirelessly coupled, connected, or responsive.As used herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. Well-known functions or constructions may not be described indetail for brevity and/or clarity. The term “and/or” includes any andall combinations of one or more of the associated listed items.

It will be understood that although the terms first, second, third, etc.may be used herein to describe various elements/operations, theseelements/operations should not be limited by these terms. These termsare only used to distinguish one element/operation from anotherelement/operation. Thus, a first element/operation in some embodimentscould be termed a second element/operation in other embodiments withoutdeparting from the teachings of present inventive concepts. The samereference numerals or the same reference designators denote the same orsimilar elements throughout the specification.

As used herein, the terms “comprise”, “comprising”, “comprises”,“include”, “including”, “includes”, “have”, “has”, “having”, or variantsthereof are open-ended, and include one or more stated features,integers, elements, steps, components, or functions but does notpreclude the presence or addition of one or more other features,integers, elements, steps, components, functions, or groups thereof.Furthermore, as used herein, the common abbreviation “e.g.”, whichderives from the Latin phrase “exempli gratia,” may be used to introduceor specify a general example or examples of a previously mentioned item,and is not intended to be limiting of such item. The common abbreviation“i.e.”, which derives from the Latin phrase “id est,” may be used tospecify a particular item from a more general recitation.

Example embodiments are described herein with reference to blockdiagrams and/or flowchart illustrations of computer-implemented methods,apparatus (systems and/or devices) and/or computer program products. Itis understood that a block of the block diagrams and/or flowchartillustrations, and combinations of blocks in the block diagrams and/orflowchart illustrations, can be implemented by computer programinstructions that are performed by one or more computer circuits. Thesecomputer program instructions may be provided to a processor circuit ofa general purpose computer circuit, special purpose computer circuit,and/or other programmable data processing circuit to produce a machine,such that the instructions, which execute via the processor of thecomputer and/or other programmable data processing apparatus, transformand control transistors, values stored in memory locations, and otherhardware components within such circuitry to implement thefunctions/acts specified in the block diagrams and/or flowchart block orblocks, and thereby create means (functionality) and/or structure forimplementing the functions/acts specified in the block diagrams and/orflowchart block(s).

These computer program instructions may also be stored in a tangiblecomputer-readable medium that can direct a computer or otherprogrammable data processing apparatus to function in a particularmanner, such that the instructions stored in the computer-readablemedium produce an article of manufacture including instructions whichimplement the functions/acts specified in the block diagrams and/orflowchart block or blocks. Accordingly, embodiments of present inventiveconcepts may be embodied in hardware and/or in software (includingfirmware, resident software, micro-code, etc.) that runs on a processorsuch as a digital signal processor, which may collectively be referredto as “circuitry,” “a module” or variants thereof.

It should also be noted that in some alternate implementations, thefunctions/acts noted in the blocks may occur out of the order noted inthe flowcharts. For example, two blocks shown in succession may in factbe executed substantially concurrently or the blocks may sometimes beexecuted in the reverse order, depending upon the functionality/actsinvolved. Moreover, the functionality of a given block of the flowchartsand/or block diagrams may be separated into multiple blocks and/or thefunctionality of two or more blocks of the flowcharts and/or blockdiagrams may be at least partially integrated. Finally, other blocks maybe added/inserted between the blocks that are illustrated, and/orblocks/operations may be omitted without departing from the scope ofinventive concepts. Moreover, although some of the diagrams includearrows on communication paths to show a primary direction ofcommunication, it is to be understood that communication may occur inthe opposite direction to the depicted arrows.

Although several embodiments of inventive concepts have been disclosedin the foregoing specification, it is understood that many modificationsand other embodiments of inventive concepts will come to mind to whichinventive concepts pertain, having the benefit of teachings presented inthe foregoing description and associated drawings. It is thus understoodthat inventive concepts are not limited to the specific embodimentsdisclosed hereinabove, and that many modifications and other embodimentsare intended to be included within the scope of the appended claims. Itis further envisioned that features from one embodiment may be combinedor used with the features from a different embodiment(s) describedherein. Moreover, although specific terms are employed herein, as wellas in the claims which follow, they are used only in a generic anddescriptive sense, and not for the purposes of limiting the describedinventive concepts, nor the claims which follow. The entire disclosureof each patent and patent publication cited herein is incorporated byreference herein in its entirety, as if each such patent or publicationwere individually incorporated by reference herein. Various featuresand/or potential advantages of inventive concepts are set forth in thefollowing claims.

What is claimed is:
 1. A method of operating an image-guided surgical system using imaging information for a 3-dimensional anatomical volume, the method comprising: detecting a pose of a probe based on information received from a tracking system, wherein the probe defines a longitudinal axis; determining a placement of a virtual implant for the 3-dimensional anatomical volume based on the pose of the probe and based on an offset from an end of the probe along the longitudinal axis, such that a trajectory of the virtual implant is in alignment with the longitudinal axis of the probe in the pose; and after determining the placement of the virtual implant, adjusting the virtual implant responsive to movement of the probe while maintaining the trajectory of the virtual implant.
 2. The method of claim 1 further comprising: providing first reformatted image data to be rendered on a display based on the imaging information and based on the placement of the virtual implant, the imaging information including 3-dimensional anatomical imaging information for the 3-dimensional anatomical volume; and after providing the first reformatted image data, providing second reformatted image data to be rendered on the display based on adjusting the virtual implant.
 3. The method of claim 2, wherein adjusting comprises adjusting the virtual implant responsive to movement of the probe and responsive to user input separate from the movement of the probe while maintaining the trajectory of the virtual implant.
 4. The method of claim 3, wherein the user input is first user input, the method further comprising: responsive to second user input separate from the movement of the probe, storing information regarding the virtual implant based on the trajectory of the virtual implant and based on the adjusting.
 5. The method of claim 4, further comprising: controlling a robotic actuator to position an end-effector based on the information regarding the virtual implant.
 6. The method of claim 1, wherein adjusting the virtual implant comprises moving the placement of the virtual implant along the trajectory responsive to movement of the probe.
 7. The method of claim 6, wherein moving the virtual implant comprises moving the virtual implant along the trajectory responsive to detecting rotation of the probe about the longitudinal axis of the probe.
 8. The method of claim 7, wherein moving the virtual implant comprising moving the virtual implant in a first direction along the trajectory responsive to detecting rotation of the probe in a first rotational direction and moving the virtual implant in a second direction along the trajectory responsive to detecting rotation of the probe in a second rotational direction.
 9. The method of claim 7, wherein moving the virtual implant comprises moving the virtual implant along the trajectory responsive to detecting rotation of the probe about the longitudinal axis of the probe in a first direction and maintaining a position of the virtual implant responsive to detecting rotation of the probe about the longitudinal axis of the probe in a second direction different than the first direction.
 10. The method of claim 6, wherein moving the virtual implant comprises moving the virtual implant along the trajectory responsive to detecting movement of a tip of the probe in a direction that is nonparallel with respect to the trajectory of the virtual implant.
 11. The method of claim 10, wherein moving the virtual implant comprises moving the virtual implant in a first direction along the trajectory responsive to detecting movement of the tip of the probe away from the trajectory of the virtual implant and moving the virtual implant in a second direction along the trajectory responsive to detecting movement of the tip of the probe toward the trajectory.
 12. The method of claim 6, wherein moving the virtual implant comprises moving the virtual implant along the trajectory responsive to detecting movement of a tip of the probe around the trajectory of the virtual implant.
 13. The method of claim 12 wherein moving the virtual implant comprises moving the virtual implant in a first direction along the trajectory responsive to detecting movement of the tip of the probe in a clockwise direction around the trajectory and moving the virtual implant in a second direction along the trajectory responsive to detecting movement of the tip of the probe in a counter clockwise direction around the trajectory.
 14. The method of claim 12, wherein a scale of movement of the virtual implant along the trajectory relative to movement of the tip is based on a distance of the tip from the trajectory.
 15. The method of claim 1, where adjusting the virtual implant comprises changing a size of the virtual implant responsive to movement of the probe while maintaining the trajectory of the virtual implant.
 16. The method of claim 15, wherein the virtual implant comprises a virtual screw and wherein adjusting the size comprises at least one of changing a length and/or changing a width of the virtual screw responsive to movement of the probe.
 17. The method of claim 1, wherein the probe comprises a plurality of spaced apart tracking markers, and wherein detecting the pose of the probe comprises detecting the pose based on the tracking system detecting the tracking markers.
 18. A surgical navigation system using imaging information for a 3-dimensional anatomical volume, the surgical navigation system comprising: a processor; and memory coupled with the processor, wherein the memory comprises instructions stored therein, and wherein the instructions are executable by the processor to cause the processor to: detect a pose of a probe based on information received from a tracking system, wherein the probe defines a longitudinal axis; determine a placement of a virtual implant for the 3-dimensional anatomical volume based on the pose of the probe and based on an offset from an end of the probe along the longitudinal axis, such that a trajectory of the virtual implant is in alignment with the longitudinal axis of the probe in the pose; and after providing the placement of the virtual implant, adjust the virtual implant responsive to movement of the probe while maintaining the trajectory of the virtual implant.
 19. The surgical navigation system of claim 18, wherein the surgical navigation system is an image-guided surgical system and the imaging information is 3-dimensional anatomical imaging information, wherein the instructions are further executable by the processor for causing the processor to: provide first reformatted image data to be rendered on a display based on the 3-dimensional anatomical imaging information and based on the placement of the virtual implant; and after providing the first reformatted image data, provide second reformatted image data to be rendered on the display based on adjusting the virtual implant.
 20. The surgical navigation system of claim 19, wherein the instructions for causing the processor to adjust the virtual implant comprises causing the processor to adjust the virtual implant responsive to movement of the probe and responsive to user input separate from the movement of the probe while maintaining the trajectory of the virtual implant. 